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Ohio 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
$28.76 / $28.76 / $80.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.46 / $28.76 / $38.75
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
$41.19 / $48.29 / $77.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.97 / $20.53 / $57.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.95 / $45.26 / $61.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.42 / $45.26 / $96.91
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 / $21.27 / $35.53
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $29.14 / $29.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.00 / $33.00 / $43.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $21.16 / $32.60