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Texas rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.24 / $8.10 / $9.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.13 / $8.21 / $10.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.14 / $11.65 / $34.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.95 / $5.95 / $6.68
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.50 / $12.50 / $12.50
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 / $7.51
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.14 / $110.75 / $110.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $9.09 / $12.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.23 / $10.63 / $12.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $8.94 / $12.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $9.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.42 / $5.77 / $7.60
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.09 / $6.26 / $12.50