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Missouri rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.36 / $8.72 / $12.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.36 / $6.75 / $13.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.09 / $6.09 / $10.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.95 / $7.51 / $7.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $8.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $11.19 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $6.24 / $15.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.16 / $6.19 / $9.39