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Alaska rates for HCPCS A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $56.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $61.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $87.10 / $87.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $91.20 / $295.12
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $87.10 / $91.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $87.10 / $109.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $25.70 / $93.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $60.26 / $85.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $85.11 / $194.98