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Nebraska 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
$220.66 / $220.66 / $220.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.66 / $220.66 / $294.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.19 / $257.62 / $260.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $293.12 / $293.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.39 / $293.12 / $452.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.59 / $266.47 / $1,247.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.45 / $132.94 / $221.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.26 / $293.12 / $369.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.00 / $346.41 / $603.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $132.94 / $204.85