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Vermont 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
Professional
Modifier
Low / Median / High Price
$22.82 / $29.34 / $29.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.60 / $36.60 / $36.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $36.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $23.06
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $36.85
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $23.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.78 / $29.69 / $45.67