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Washington rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.09 / $16.09 / $16.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.38 / $7.73 / $28.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.95 / $75.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $10.95 / $108.14
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 / $8.58
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.18 / $13.24 / $23.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.18 / $14.25 / $23.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.41 / $9.35 / $10.28
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.44 / $10.38 / $12.50
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.44 / $10.63 / $12.50
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.38 / $10.95 / $25.03
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.38 / $11.84 / $22.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.90 / $12.21 / $12.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.94 / $10.63 / $13.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $5.31 / $10.11
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.93 / $5.93 / $6.09