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Wisconsin rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.08 / $10.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.22 / $18.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $10.23 / $12.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $38.90 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $17.78 / $20.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $8.91 / $15.85
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $22.39 / $28.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $10.96 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $6.17 / $13.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $16.60 / $33.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $21.88 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $12.88 / $109.65
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $5.62 / $7.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $5.37 / $10.00