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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $23.99 / $23.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $28.18 / $36.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $29.51 / $61.66
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $72.44 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $21.38 / $218.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $30.90 / $33.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $23.99 / $34.67