go back

Wisconsin 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

Facilitymedian $55 · 10th–90th $51–$1000%20%40%10th90th$55Professionalmedian $39 · 10th–90th $26–$830%10%20%10th90th$39$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $30.90 / $30.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $31.62 / $45.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $51.29 / $61.66
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $169.82 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $77.62 / $104.71
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $46.77 / $77.62
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $72.44 / $89.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $53.70 / $251.19
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $34.67 / $63.10
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $34.67 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $61.66 / $107.15
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $83.18 / $151.36
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $109.65 / $257.04
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $52.48 / $269.15
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $38.90 / $54.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $26.92 / $50.12