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Utah 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
$3.42 / $3.42 / $3.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.42 / $8.10 / $36.09
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 / $7.51 / $14.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.36 / $7.79 / $10.47
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.31 / $10.38 / $10.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $7.44 / $11.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $5.30 / $5.94