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West Virginia 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
$29.83 / $29.83 / $29.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.44 / $33.15 / $36.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.15 / $73.01 / $94.64
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.15 / $37.86 / $64.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $63.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $35.60 / $260.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.52 / $28.31 / $44.96