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South Dakota 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 $39 · 10th–90th $34–$680%20%10th90th$39Professionalmedian $39 · 10th–90th $27–$720%10%20%10th90th$39$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $33.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $34.67 / $72.44
Avera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $57.54 / $58.88
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
$63.10 / $63.10 / $77.62
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $58.88 / $102.33
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $40.74 / $269.15
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $58.88 / $58.88
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $60.26
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $48.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $53.70 / $70.79
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $40.74 / $63.10
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48