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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 patient's foot (custom molded shoe), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $169.82 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $269.15 / $323.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $181.97 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $194.98 / $269.15
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $158.49 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $131.83 / $204.17