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Utah rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $7.94 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.31 / $8.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $7.76 / $12.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $9.33 / $16.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $7.59 / $11.48
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $10.72 / $12.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $10.96 / $12.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $4.79 / $4.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $5.25 / $7.59