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Connecticut rates for HCPCS A5501

For Diabetics Only Fitting (Including Follow-Up) Custom Preparation And Supply Of Shoe Molded From Cast(S) Of Patients Foot (Custom Molded Shoe) Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.48 / $171.48 / $171.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.96 / $171.48 / $189.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.51 / $266.47 / $304.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.26 / $171.26 / $180.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $178.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $130.22 / $178.39
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.21 / $173.21 / $173.21
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.21 / $186.53 / $266.47
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.64 / $213.64 / $213.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.45 / $132.94 / $221.57