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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 Multi- Density Insert(S) Per Shoe. (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.59 / $51.59 / $51.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.60 / $51.59 / $71.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $97.74 / $161.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.95 / $82.63 / $109.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.91 / $106.62 / $190.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.85 / $93.29 / $124.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.47 / $265.00 / $370.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $130.97 / $168.16
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.75 / $74.42 / $102.18
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.86 / $88.85 / $106.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.58 / $92.86 / $415.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.30 / $59.36 / $104.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.29 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.75 / $77.39 / $102.18
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.86 / $88.85 / $106.62
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.85 / $136.72 / $238.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.47 / $173.54 / $415.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $59.47 / $442.47
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.85 / $88.85 / $88.85
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.85 / $88.85 / $88.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.39 / $57.23 / $84.95