go back

Utah 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
$22.06 / $22.06 / $22.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.52 / $22.06 / $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 / $35.59 / $62.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.35 / $52.81 / $52.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $37.86 / $56.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.01 / $24.28 / $38.10