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Wisconsin 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 $55 · 10th–90th $51–$1000%20%40%10th90th$55Professionalmedian $43 · 10th–90th $26–$830%10%20%10th90th$43$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
$30.90 / $30.90 / $30.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $32.36 / $46.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $51.29 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $169.82 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $77.62 / $104.71
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $46.77 / $64.57
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $57.54 / $66.07
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $53.70 / $251.19
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $29.51 / $63.10
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $58.88 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $67.61 / $134.90
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $83.18 / $154.88
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $109.65 / $257.04
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $52.48 / $269.15
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $29.51 / $54.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $26.92 / $51.29