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Oklahoma 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
$32.36 / $32.36 / $32.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $30.90 / $46.77
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $38.90 / $54.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $47.86 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $58.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $38.02 / $251.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $28.18 / $66.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $38.02 / $54.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $24.55 / $37.15