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New Mexico 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
$39.29 / $39.29 / $39.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $32.45 / $156.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.40 / $43.20 / $51.47
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 / $43.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.37 / $79.22 / $110.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.68 / $15.68 / $40.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $36.21 / $63.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.05 / $24.28 / $38.51