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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
$32.20 / $32.20 / $37.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $32.20 / $35.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $54.08 / $54.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.35 / $47.35 / $47.35
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.68 / $33.81 / $253.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $28.87 / $54.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $24.39 / $38.04