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Maine 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
Professional
Modifier
Low / Median / High Price
$26.22 / $50.97 / $50.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.02 / $102.38 / $189.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.66 / $60.02 / $60.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.47 / $59.47 / $74.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $52.43 / $59.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $72.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.75 / $46.68 / $50.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.55 / $63.26 / $101.92