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Indiana 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
$46.32 / $46.32 / $54.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.48 / $34.32 / $46.32
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $40.56 / $54.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.72 / $48.40 / $54.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.40 / $34.94 / $47.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.97 / $62.19 / $81.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $64.90 / $75.70
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 / $55.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $26.98 / $41.58