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Maine rates for HCPCS A5114

Leg strap; foam or fabric, replacement only, per set

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.08 / $21.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $8.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $7.59 / $8.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.31 / $8.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $9.33 / $11.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.94 / $22.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $4.79 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $6.17 / $10.96