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Maine 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
Professional
Modifier
Low / Median / High Price
$78.67 / $152.88 / $152.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.00 / $307.05 / $569.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.26 / $180.05 / $180.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $192.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $157.24 / $178.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.29 / $217.29 / $217.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.67 / $152.88 / $152.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.63 / $189.75 / $305.70