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New Mexico 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
$32.84 / $32.84 / $32.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.16 / $32.04 / $123.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.15 / $36.20 / $43.06
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 / $31.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.20 / $45.26 / $67.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $11.45 / $29.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $29.14 / $53.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.11 / $30.99 / $33.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.37 / $19.19 / $30.38