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West Virginia rates for HCPCS A5513

For Diabetics Only Multiple Density Insert Custom Molded From Model Of Patients Foot Total Contact With Patients 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
$29.83 / $29.83 / $29.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $33.15 / $34.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $64.90 / $81.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $64.90 / $125.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $63.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $36.21 / $260.67
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.50 / $41.13 / $42.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.35 / $30.72 / $44.96