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Diabetic Custom Insert, Multiple Density, CAD/CAM Carved

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

Rates data updated July 2026.

Facilitymedian $55 · 10th–90th $47$1000%20%40%10th90th$55Professionalmedian $51 · 10th–90th $26$930%20%10th90th$51$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
$31.62
Median
$31.62
Typical High
$31.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$31.62
Typical High
$46.77
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$91.20
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$51.29
Typical High
$61.66
Cigna
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$169.82
Typical High
$281.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$79.43
Typical High
$104.71
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$46.77
Typical High
$64.57
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$57.54
Typical High
$66.07
Medica
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$53.70
Typical High
$251.19
Medica
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$29.51
Typical High
$63.10
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$58.88
Typical High
$70.79
Network Health
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$67.61
Typical High
$134.90
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$46.77
Typical High
$64.57
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$53.70
Quartz
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$83.18
Typical High
$151.36
Quartz
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$112.20
Typical High
$257.04
Quartz
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$81.28
Typical High
$275.42
Security Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
Security Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
United
Setting
Facility
Modifier
Global
Typical Low
$17.78
Median
$29.51
Typical High
$54.95
United
Setting
Professional
Modifier
Global
Typical Low
$19.05
Median
$26.92
Typical High
$54.95