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Montana 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
$38.78 / $123.29 / $123.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.25 / $44.25 / $44.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $47.52 / $47.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $47.52 / $47.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.82 / $45.26 / $47.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.01 / $35.61 / $47.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $22.70 / $22.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.03 / $19.19 / $33.53