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Montana rates for HCPCS A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.60 / $27.60 / $76.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.77 / $86.77 / $86.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.47 / $93.29 / $93.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.47 / $93.29 / $93.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.58 / $88.85 / $93.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.25 / $70.02 / $93.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.04 / $39.89 / $68.29