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Tennessee 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $22.95 / $28.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $28.13 / $38.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.93 / $40.72 / $40.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.80 / $29.14 / $29.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $29.14
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $211.82 / $214.99
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.39 / $225.39 / $339.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.37 / $26.10 / $33.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.79 / $20.79 / $31.10