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Texas 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
$22.55 / $29.28 / $33.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.55 / $29.68 / $39.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.54 / $60.40 / $126.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $21.53 / $24.14
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $45.26 / $45.26
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.82 / $214.99 / $214.99
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.39 / $225.39 / $339.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $31.68 / $45.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.70 / $40.72 / $45.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $29.68 / $45.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $37.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.99 / $24.14 / $29.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.14 / $27.58 / $45.26