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Tennessee 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
$137.65 / $137.65 / $170.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.96 / $164.29 / $233.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.76 / $239.82 / $239.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.40 / $178.39 / $178.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $130.22 / $178.39
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.35 / $1,247.08 / $1,265.73
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.02 / $1,327.02 / $1,998.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.09 / $129.62 / $189.75