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Maine 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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.01 / $24.52 / $24.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.25 / $52.15 / $96.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.09 / $29.34 / $29.34
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 / $23.32 / $29.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.85 / $34.85 / $34.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.82 / $24.52 / $24.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.56 / $30.99 / $30.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $25.31 / $50.10