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Missouri 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
$19.38 / $30.19 / $45.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.38 / $25.41 / $49.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $45.26 / $45.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $47.52 / $208.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.79 / $27.14 / $34.85
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 / $21.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.60 / $38.47 / $211.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.99 / $21.32 / $52.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.93 / $21.32 / $40.72