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Illinois 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
$30.37 / $30.37 / $30.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.45 / $30.37 / $47.35
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.63 / $37.86 / $40.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.30 / $312.95 / $626.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.56 / $40.56 / $41.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $59.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $35.59 / $62.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $73.38 / $114.83
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.30 / $70.30 / $70.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.52 / $67.59 / $81.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.23 / $26.98 / $47.77