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Missouri 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 $54 · 10th–90th $28–$1620%20%10th90th$54Professionalmedian $33 · 10th–90th $24–$560%10%10th90th$33$5.0$10.0$20.0$50.0$100.0$200.0

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
$22.91 / $53.70 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $34.67 / $58.88
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $194.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $30.90 / $53.70
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $33.11 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $35.48
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $53.70 / $251.19
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.50 / $26.92 / $83.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $43.65 / $43.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.50 / $26.92 / $47.86