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West Virginia 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
$24.93 / $24.93 / $24.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.93 / $27.18 / $30.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.42 / $61.10 / $79.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.42 / $31.68 / $54.31
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 / $29.14 / $218.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.10 / $30.99 / $30.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.87 / $22.83 / $34.32