go back

Missouri rates for HCPCS A5513

For Diabetics Only Multiple Density Insert Custom Molded From Model Of Patients Foot Total Contact With Patients 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
$23.16 / $37.72 / $54.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.48 / $30.37 / $56.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.78 / $37.86 / $54.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $56.78 / $249.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.63 / $34.94 / $43.89
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 / $38.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.15 / $48.67 / $253.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.23 / $26.98 / $65.01
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.75 / $49.75 / $49.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.12 / $26.98 / $41.58