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Illinois rates for HCPCS A5510

For Diabetics Only Direct Formed Compression Molded To Patients Foot Without External Heat Source Multiple-Density Insert(S) Prefabricated Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.74 / $32.74 / $32.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.90 / $23.90 / $32.74
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.15 / $93.75 / $102.75
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $1,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.94 / $88.94 / $128.79