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Missouri 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
$19.38 / $30.19 / $45.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.38 / $25.41 / $49.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $45.26 / $45.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $47.52 / $208.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.79 / $28.09 / $35.29
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 / $21.27 / $31.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.82 / $38.47 / $211.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.99 / $21.32 / $52.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.92 / $30.38 / $36.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.70 / $21.32 / $33.53