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Oregon 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
Professional
Modifier
Low / Median / High Price
$15.97 / $18.48 / $100.86
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 / $36.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.56 / $54.08 / $125.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.69 / $47.40 / $56.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.21 / $50.84 / $56.78
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.94 / $52.81 / $59.49
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.26 / $54.08 / $54.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.52 / $47.35 / $59.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $47.35 / $59.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.05 / $89.92 / $189.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.51 / $59.49 / $59.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.11 / $24.28 / $46.32