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Indiana 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
$46.32 / $46.32 / $54.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.79 / $34.33 / $46.32
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $40.56 / $54.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.72 / $48.40 / $54.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.47 / $26.47 / $40.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.56 / $59.49 / $81.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.97 / $59.49 / $73.01
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 / $35.59 / $55.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $26.79 / $39.20