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Minnesota 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
$33.88 / $33.88 / $33.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $33.88 / $46.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $53.70 / $79.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $53.70 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $204.17 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $70.79 / $79.43
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $199.53 / $380.19
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $67.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $53.70 / $251.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $26.92 / $64.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $38.02 / $41.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $26.92 / $67.61