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Michigan rates for HCPCS A5510

For Diabetics Only Direct Formed Compression Molded To Patients Foot Without External Heat Source Multiple-Density Insert(S) Prefabricated Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $67.50 / $67.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.13 / $67.50 / $91.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.66 / $19.66 / $28.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.74 / $32.74 / $32.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.90 / $32.74 / $33.72
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $29.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.76 / $30.00 / $43.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.94 / $88.94 / $88.94