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New Mexico 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
$39.29 / $39.29 / $39.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.44 / $38.35 / $156.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.40 / $43.20 / $43.56
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 / $35.59 / $43.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.24 / $52.81 / $79.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.65 / $35.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $35.60 / $63.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.52 / $24.28 / $39.20