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Illinois rates for HCPCS A5503

For Diabetics Only Modification (Including Fitting) Of Off-The- Shelf Depth-Inlay Shoe Or Custom-Molded Shoe With Roller Or Rigid Rocker Bottom Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.41 / $25.41 / $25.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.10 / $25.41 / $45.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.00 / $110.62 / $394.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.21 / $33.95 / $33.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $49.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $29.14 / $52.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.00 / $53.96 / $67.89
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.84 / $58.84 / $58.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.12 / $36.19 / $66.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $30.99 / $45.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.99 / $21.32 / $41.57