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Colorado 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
$23.25 / $23.25 / $23.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $23.25 / $38.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.32 / $110.32 / $110.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.94 / $34.94 / $37.74
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 / $26.43 / $56.78
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.68 / $23.25 / $73.01
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.68 / $15.68 / $15.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.56 / $67.59 / $107.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.05 / $24.28 / $40.46