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Montana rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.73 / $28.00 / $36.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.21 / $12.21 / $12.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.51 / $13.13 / $13.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $13.13 / $13.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.08 / $12.50 / $13.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.58 / $9.86 / $13.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $5.30 / $6.24