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Wisconsin 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
$6.32 / $6.32 / $6.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.32 / $6.73 / $10.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.89 / $11.98 / $19.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.13 / $10.13 / $13.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.83 / $23.30 / $23.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.51 / $33.34 / $51.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $18.10 / $20.60
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $8.91 / $12.52
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.08 / $10.89 / $13.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.08 / $11.69 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.93 / $6.32 / $13.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.87 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $9.48 / $12.99
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.08 / $10.89 / $13.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.89 / $18.55 / $32.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.51 / $21.26 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $7.51 / $108.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.89 / $10.89 / $10.89
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.89 / $10.89 / $10.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.15 / $5.72 / $10.46