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North Carolina 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
$47.35 / $47.35 / $47.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $47.35 / $47.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.59 / $80.22 / $98.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.65 / $40.56 / $44.56
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 / $35.60 / $62.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.65 / $47.35 / $56.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.56 / $44.56 / $44.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.90 / $64.90 / $64.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $26.74 / $43.56
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.85 / $256.88 / $256.88
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.32 / $405.60 / $405.60