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Washington 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 Multi- Density Insert(S) Per Shoe. (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.33 / $114.25 / $119.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.60 / $50.33 / $87.07
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.20 / $79.97 / $88.85
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.80 / $169.20 / $415.82
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.02 / $79.30 / $442.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.47 / $59.47 / $59.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $43.41 / $69.80
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.57 / $90.63 / $161.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.11 / $92.81 / $169.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.35 / $83.73 / $94.31
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.93 / $86.77 / $88.85
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.63 / $88.85 / $88.85
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.75 / $77.80 / $169.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.75 / $84.17 / $127.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.57 / $86.77 / $86.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.98 / $75.52 / $97.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.89 / $60.08 / $76.11
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $54.08 / $57.66