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Illinois rates for HCPCS A5513

For Diabetics Only Multiple Density Insert Custom Molded From Model Of Patients Foot Total Contact With Patients 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
$30.37 / $30.37 / $30.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $30.37 / $54.04
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.56 / $40.56 / $40.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.19 / $136.61 / $473.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.57 / $40.56 / $40.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $59.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $36.21 / $62.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.38 / $62.19 / $98.85
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.30 / $70.30 / $70.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.75 / $45.36 / $79.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.59 / $26.98 / $46.31