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Iowa 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 / $223.87 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $169.82 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $309.03 / $389.05
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $295.12 / $316.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $295.12 / $1,258.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $190.55 / $457.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $302.00 / $363.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $446.68 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $177.83 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $131.83 / $245.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $263.03 / $263.03