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Oklahoma 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
$26.91 / $26.91 / $27.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.51 / $26.51 / $26.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.93 / $39.57 / $39.57
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 / $52.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $27.84 / $211.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.79 / $22.83 / $44.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.79 / $20.04 / $29.29