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Minnesota 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 / $229.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $269.15 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $269.15 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,000.00 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $354.81 / $389.05
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $954.99 / $1,862.09
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $269.15 / $1,258.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $120.23 / $295.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $186.21 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $131.83 / $331.13