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Diabetic Custom Insert, Multiple Density, CAD/CAM Carved

Utah 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 $28 · 10th–90th $22$540%20%40%10th90th$28Professionalmedian $36 · 10th–90th $19$2340%5%10%10th90th$36$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
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$21.88
Typical High
$21.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$34.67
Typical High
$234.42
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
$36.31
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$60.26
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$53.70
Typical High
$53.70
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$60.26
Select Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
Select Health
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$53.70
Typical High
$54.95
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$54.95
Typical High
$66.07
United
Setting
Facility
Modifier
Global
Typical Low
$22.39
Median
$38.02
Typical High
$41.69
United
Setting
Professional
Modifier
Global
Typical Low
$19.05
Median
$24.55
Typical High
$41.69