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Georgia 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
Facility
Modifier
Low / Median / High Price
$34.24 / $34.24 / $34.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.51 / $35.99 / $49.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.04 / $40.02 / $40.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $75.70 / $198.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $49.01 / $99.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.97 / $54.08 / $106.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.97 / $45.97 / $45.97
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 / $62.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.10 / $54.08 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $26.98 / $50.09