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Ohio 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
$169.14 / $169.14 / $570.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.16 / $169.14 / $228.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.49 / $284.32 / $457.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.63 / $149.55 / $346.41
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.47 / $266.47 / $266.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.85 / $266.47 / $359.73
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.21 / $266.47 / $570.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $312.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $130.22 / $209.38
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $178.39
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $178.39 / $178.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.15 / $176.20 / $231.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.63 / $132.94 / $204.85