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Alaska rates for HCPCS A5513

For diabetics only, multiple density insert, custom molded from model of patient's foot, 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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.47 / $51.47 / $51.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $36.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $36.21 / $37.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.68 / $15.68 / $15.68
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.38 / $51.38 / $81.12
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.35 / $47.35 / $52.81
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.79 / $52.81 / $108.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.68 / $15.68 / $44.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.21 / $43.56 / $66.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.98 / $51.70 / $94.42