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Montana 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
$18.44 / $25.22 / $156.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.81 / $52.81 / $52.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $56.78 / $56.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.60 / $56.78 / $56.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $54.08 / $56.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.67 / $42.62 / $56.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.52 / $24.28 / $27.79