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Washington 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 $45–$1120%20%40%10th90th$54Professionalmedian $38 · 10th–90th $22–$720%10%10th90th$38$0.5$2.0$10.0$50.0$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
$30.20 / $30.20 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $30.90 / $51.29
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $52.48 / $52.48
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $35.48
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $95.50 / $128.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $95.50 / $128.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $100.00
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $53.70
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $81.28 / $107.15
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $52.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $60.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.39 / $33.11 / $43.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $28.18 / $46.77
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $46.77 / $83.18