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Wyoming 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
$22.91 / $33.88 / $77.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $47.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.90 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $24.55 / $41.69