go back

Montana rates for HCPCS A5505

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with metatarsal bar, per shoe

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.78 / $123.29 / $123.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.50 / $47.52 / $47.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.50 / $47.52 / $47.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.82 / $45.26 / $47.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.36 / $35.61 / $47.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.03 / $19.19 / $33.53