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New Mexico 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
$193.66 / $193.66 / $193.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.67 / $189.00 / $768.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.65 / $212.86 / $253.63
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 / $215.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.26 / $390.33 / $585.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.23 / $77.23 / $200.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $178.39 / $312.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.63 / $119.65 / $189.75