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Texas rates for HCPCS A5505

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with metatarsal bar, per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.55 / $29.28 / $33.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.55 / $29.68 / $39.57
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $45.26 / $45.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.50 / $28.50 / $28.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.81 / $20.81 / $28.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $214.99 / $214.99
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.39 / $225.39 / $339.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $31.68 / $45.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.70 / $40.72 / $45.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $29.68 / $45.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.81 / $20.81 / $35.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.99 / $24.14 / $30.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.87 / $45.26