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Diabetic Custom Insert, Multiple Density, CAD/CAM Carved

New Hampshire 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 $55 · 10th–90th $31$680%20%10th90th$55Professionalmedian $37 · 10th–90th $25$480%20%10th90th$37$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
Facility
Modifier
Global
Typical Low
$30.90
Median
$30.90
Typical High
$37.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$30.90
Typical High
$37.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$54.95
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$58.88
Typical High
$67.61
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$30.90
Typical High
$30.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$35.48
Typical High
$35.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$25.70
Typical High
$43.65
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$25.70
Typical High
$41.69
United
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$34.67
Typical High
$47.86
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$56.23
Typical High
$77.62