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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
$114.82 / $173.78 / $537.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $316.23 / $363.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $190.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $281.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $173.78 / $537.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $186.21 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $190.55 / $251.19