go back

Rhode Island 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
Professional
Modifier
Low / Median / High Price
$13.50 / $17.93 / $28.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.74 / $86.53 / $101.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.39 / $22.82 / $39.83
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 / $29.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.10 / $26.10 / $26.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.19 / $30.00 / $35.53