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Idaho 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
$15.85 / $30.20 / $72.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $51.29 / $79.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $60.26 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $37.15
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $52.48 / $77.62
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $52.48 / $54.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $38.02 / $38.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $52.48 / $52.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $54.95 / $54.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $24.55 / $41.69