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Texas rates for HCPCS A5507

For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe, per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $28.84 / $32.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $28.84 / $38.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $21.38 / $23.99
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $21.38 / $28.84
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $338.84 / $338.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $37.15 / $63.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $28.84 / $45.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $29.51 / $35.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $34.67 / $64.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $21.38 / $31.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $29.51 / $33.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $23.99 / $30.90
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71