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Diabetic Custom Insert, Multiple Density, CAD/CAM Carved

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

Rates data updated July 2026.

Facilitymedian $54 · 10th–90th $44$1100%20%40%10th90th$54Professionalmedian $45 · 10th–90th $22$1000%10%20%10th90th$45$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
$30.90
Median
$30.90
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$30.90
Typical High
$74.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$52.48
Typical High
$53.70
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$60.26
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
$35.48
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$95.50
Typical High
$128.82
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$95.50
Typical High
$128.82
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$100.00
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$53.70
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$81.28
Typical High
$107.15
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$52.48
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$53.70
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$60.26
United
Setting
Facility
Modifier
Global
Typical Low
$22.39
Median
$38.02
Typical High
$43.65
United
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$28.84
Typical High
$47.86
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$46.77
Typical High
$83.18