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Wisconsin 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
Facility
Modifier
Low / Median / High Price
$31.40 / $31.40 / $31.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.56 / $31.40 / $44.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $59.49 / $98.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.29 / $50.29 / $66.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $115.73 / $115.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $161.00 / $225.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $79.53 / $102.35
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.40 / $46.79 / $62.19
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $64.90 / $64.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.65 / $56.52 / $253.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.28 / $32.45 / $63.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.44 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.40 / $47.10 / $62.19
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $64.90 / $64.90
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $81.12 / $145.54
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $105.62 / $253.09
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $35.60 / $269.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $54.08 / $54.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $54.08 / $54.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.23 / $28.32 / $51.70