go back

Maine 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 / $31.02 / $38.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.10 / $62.32 / $115.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $30.75 / $30.75
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 / $35.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.09 / $44.09 / $44.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.25 / $31.02 / $31.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.60 / $29.40 / $76.23