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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
$23.25 / $23.25 / $47.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.81 / $52.81 / $52.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.81 / $52.81 / $52.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $59.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $26.43 / $36.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.95 / $24.28 / $41.58