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Maine 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
$15.97 / $31.02 / $31.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.10 / $62.32 / $115.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.94 / $36.54 / $36.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $39.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $29.14 / $36.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.09 / $44.09 / $44.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.67 / $28.43 / $31.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.71 / $38.51 / $62.05