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New York 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
$38.02 / $70.79 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $54.95 / $125.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $67.61 / $75.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $181.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $57.54 / $154.88
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $74.13 / $74.13
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $141.25 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $89.13
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $147.91 / $346.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $95.50 / $173.78
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $70.79
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $54.95 / $67.61
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $44.67
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $87.10 / $87.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $52.48 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $46.77 / $77.62
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $67.61 / $70.79
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $54.95 / $67.61