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Minnesota 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
$56.23 / $56.23 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $54.95 / $77.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $89.13 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $89.13 / $89.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $331.13 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $117.49 / $131.83
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $331.13 / $630.96
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $141.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $89.13 / $416.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $44.67 / $91.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $58.88 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $44.67 / $109.65