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West Virginia 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
$24.93 / $24.93 / $24.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.93 / $27.18 / $30.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.42 / $61.10 / $79.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.42 / $31.68 / $54.31
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 / $218.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.48 / $23.75 / $34.32