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Kansas 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
$59.71 / $59.71 / $59.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.68 / $28.82 / $59.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $40.56 / $40.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.28 / $50.62 / $53.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.09 / $48.09 / $48.09
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 / $78.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.68 / $46.64 / $253.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $28.91 / $69.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $26.98 / $41.58