go back

Rhode Island 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
$18.45 / $24.51 / $35.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.62 / $103.27 / $122.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.51 / $31.19 / $48.90
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 / $35.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.60 / $30.88 / $44.96