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Michigan 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
$34.45 / $34.45 / $34.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.93 / $34.45 / $34.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $45.26 / $45.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.00 / $45.26 / $61.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.42 / $29.42 / $29.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.21 / $36.21 / $36.21
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 / $31.98 / $58.28
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.52 / $31.52 / $34.45
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.08 / $34.45 / $49.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.46 / $33.49 / $38.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.99 / $20.38 / $31.98