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Connecticut 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 Patients 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
Facility
Modifier
Low / Median / High Price
$35.99 / $35.99 / $35.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.51 / $35.51 / $38.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.91 / $54.08 / $61.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $30.75 / $30.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $35.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $25.99 / $35.60
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.15 / $35.15 / $35.15
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.15 / $35.15 / $49.75
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.23 / $71.23 / $106.86
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.36 / $43.36 / $43.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.59 / $26.98 / $47.32