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North Dakota 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
$31.09 / $31.09 / $31.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.66 / $28.85 / $31.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.32 / $50.04 / $51.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.50 / $53.03 / $66.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.82 / $31.09 / $211.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.16 / $22.39 / $34.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.79 / $31.10 / $49.79