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Ohio 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
Facility
Modifier
Low / Median / High Price
$28.76 / $28.76 / $78.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.46 / $28.76 / $38.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.19 / $48.29 / $77.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.48 / $22.17 / $58.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.95 / $45.26 / $61.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.42 / $45.26 / $96.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $53.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $33.58
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $29.14 / $29.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.00 / $33.00 / $43.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.70 / $29.23 / $36.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $21.12 / $33.53