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Hawaii 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
$17.52 / $18.44 / $18.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $35.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.60 / $43.67 / $59.49
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $56.63 / $56.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $54.08 / $75.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.52 / $53.54 / $59.49
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.56 / $45.05 / $51.47