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Maryland 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
$16.80 / $33.15 / $47.35
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.19 / $30.19 / $36.97
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 / $37.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $54.08 / $77.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.78 / $26.98 / $42.78
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.36 / $34.36 / $37.86