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Michigan 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
$8.10 / $8.10 / $8.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.87 / $8.10 / $8.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.09 / $32.06 / $58.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.10 / $10.63 / $14.35
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.91 / $6.91 / $6.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.95 / $7.51 / $7.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $7.51 / $14.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.68 / $7.68 / $8.10
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.09 / $8.10 / $11.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.07 / $9.03 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.15 / $5.08 / $7.60