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Georgia rates for HCPCS A5504

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with wedge(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.13 / $28.13 / $28.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.01 / $28.13 / $36.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $63.36 / $166.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.79 / $35.53 / $86.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.47 / $45.26 / $88.71
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.47 / $38.47 / $38.47
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 / $21.27 / $54.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.72 / $45.26 / $59.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $21.32 / $44.30