go back

Wisconsin 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
$51.29 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $51.29 / $120.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $85.11 / $102.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $107.15 / $190.55
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $281.84 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $128.82 / $169.82
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $74.13 / $128.82
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $120.23 / $147.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $89.13 / $416.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $57.54 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $134.90 / $251.19
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $181.97 / $426.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $97.72 / $446.68
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $63.10 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $44.67 / $81.28