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Illinois rates for HCPCS A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $53.70 / $97.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $66.07 / $91.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $199.53 / $776.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $66.07 / $66.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $97.72
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $95.50 / $169.82
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $70.79 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $44.67 / $69.18