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Illinois 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

Facilitymedian $30 · 10th–90th $30–$2820%20%40%90th$30Professionalmedian $39 · 10th–90th $25–$550%20%10th90th$39$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $54.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $33.11 / $54.95
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $54.95 / $72.44
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $316.23 / $602.56
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $40.74 / $40.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $58.88
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $74.13 / $114.82
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $43.65 / $43.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $26.92 / $46.77