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Louisiana 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
$31.02 / $38.22 / $38.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.02 / $38.22 / $42.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.19 / $36.83 / $56.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.28 / $33.53 / $33.53
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$744.88 / $744.88 / $744.88
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 / $29.14 / $43.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $26.14 / $39.36