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Oregon 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 Patients 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 / $30.63 / $156.01
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $102.99 / $125.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.34 / $54.08 / $59.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.67 / $54.08 / $64.90
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.81 / $54.08 / $62.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.65 / $47.35 / $54.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $47.35 / $59.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.05 / $89.92 / $189.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.51 / $59.49 / $59.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.52 / $24.28 / $46.32