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Vermont 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
$28.43 / $36.54 / $36.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.75 / $43.75 / $43.75
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 / $41.80
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $36.21
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $36.21 / $41.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $38.51 / $62.53