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Missouri 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
$114.13 / $185.84 / $266.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.13 / $149.63 / $294.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.47 / $266.47 / $266.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.47 / $279.79 / $1,230.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.15 / $171.26 / $219.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $178.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $130.22 / $191.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.89 / $239.82 / $1,247.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.71 / $132.94 / $320.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.71 / $132.94 / $255.81