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Maine 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
Professional
Modifier
Low / Median / High Price
$4.65 / $6.10 / $6.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.09 / $6.26 / $6.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.32 / $7.51 / $8.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $8.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.67 / $8.67 / $8.67
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.58 / $6.10 / $6.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $5.31 / $12.21