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Arkansas 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
Facility
Modifier
Low / Median / High Price
$43.56 / $43.56 / $43.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $43.56 / $43.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.26 / $43.26 / $43.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.68 / $61.79 / $68.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $54.08 / $67.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $54.08 / $70.30
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 / $42.48
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.75 / $49.75 / $49.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $25.78 / $38.51