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Oklahoma 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
$32.20 / $32.20 / $32.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.72 / $32.20 / $35.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $54.08 / $54.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.35 / $47.35 / $47.35
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.20 / $35.65 / $253.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $28.07 / $52.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $26.14 / $39.20