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Indiana rates for HCPCS A5503

For Diabetics Only Modification (Including Fitting) Of Off-The- Shelf Depth-Inlay Shoe Or Custom-Molded Shoe With Roller Or Rigid Rocker Bottom Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.75 / $38.75 / $45.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.93 / $28.76 / $38.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.76 / $40.51 / $45.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.48 / $28.09 / $37.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.95 / $49.79 / $67.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.47 / $49.79 / $61.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $29.14 / $46.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $29.23 / $33.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.79 / $21.32 / $32.60