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Idaho 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
$22.06 / $47.35 / $73.39
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 / $43.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.65 / $39.21 / $73.39
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.67 / $54.08 / $54.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.97 / $39.90 / $105.46
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.35 / $52.81 / $79.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $37.86 / $56.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.52 / $24.28 / $38.44