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Kentucky 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 (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.01 / $23.25 / $26.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.01 / $27.18 / $38.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $45.26 / $45.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.97 / $24.94 / $27.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.95 / $63.36 / $74.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $56.58 / $74.68
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 / $21.95 / $218.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.32 / $24.79 / $58.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $21.32 / $35.53