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North Carolina rates for HCPCS A5501

For Diabetics Only Fitting (Including Follow-Up) Custom Preparation And Supply Of Shoe Molded From Cast(S) Of Patients Foot (Custom Molded Shoe) Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.33 / $233.33 / $233.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.33 / $233.33 / $233.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.63 / $256.36 / $486.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.87 / $199.85 / $213.18
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 / $178.39 / $309.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.23 / $233.33 / $303.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.00 / $178.00 / $197.77
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.80 / $319.80 / $491.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.45 / $132.94 / $239.82
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.35 / $1,265.73 / $1,265.73
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.02 / $1,327.02 / $1,998.53