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Montana rates for HCPCS A5501

For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.66 / $768.85 / $768.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.22 / $260.22 / $260.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $279.79 / $279.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.39 / $279.79 / $279.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.69 / $266.47 / $279.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.74 / $210.00 / $280.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.14 / $119.65 / $204.85