go back

Tennessee 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
$27.93 / $27.93 / $34.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.51 / $33.34 / $47.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $54.08 / $54.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.42 / $48.67 / $48.67
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.50 / $253.09 / $256.88
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.32 / $269.32 / $405.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.64 / $26.30 / $38.44