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Vermont 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
$31.19 / $40.10 / $40.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.75 / $43.75 / $43.75
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 / $53.33
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $35.60
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $35.60 / $53.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $37.03 / $67.01