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Massachusetts rates for HCPCS A5114

Leg Strap; Foam Or Fabric Replacement Only Per Set (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.65 / $4.65 / $4.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $8.84
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.16 / $23.36 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $7.40 / $10.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.84 / $6.84 / $20.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.71 / $6.95 / $6.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.79 / $6.00 / $7.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $6.38 / $14.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.67 / $8.67 / $9.10
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $3.30 / $3.30
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.19 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $5.31 / $14.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.15 / $6.08 / $12.50