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Diabetic Custom Insert, Multiple Density, CAD/CAM Carved

Montana 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

Rates data updated July 2026.

Facilitymedian $52 · 10th–90th $38$660%20%10th90th$52Professionalmedian $48 · 10th–90th $22$660%20%10th90th$48$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
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$25.12
Typical High
$234.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$56.23
Typical High
$56.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$56.23
Typical High
$56.23
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$52.48
Typical High
$102.33
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$52.48
Typical High
$102.33
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$54.95
Typical High
$63.10
Providence
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$56.23
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$38.02
Typical High
$41.69
United
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$24.55
Typical High
$38.90