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Alaska rates for HCPCS A5514

For diabetics only, multiple density insert, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $38.90 / $72.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $35.48 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $36.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $35.48 / $54.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $54.95 / $177.83
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $52.48 / $54.95
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $52.48 / $67.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $35.48 / $54.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $39.81 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $51.29 / $117.49