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Oregon rates for HCPCS A5501

For Diabetics Only Fitting (Including Follow-Up) Custom Preparation And Supply Of Shoe Molded From Cast(S) Of Patients Foot (Custom Molded Shoe) Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.67 / $150.97 / $768.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $178.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $130.22 / $178.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.85 / $266.47 / $620.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.70 / $233.54 / $271.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.05 / $239.82 / $266.47
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.51 / $260.22 / $293.12
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.85 / $266.47 / $266.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.19 / $231.10 / $267.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $233.33 / $293.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.01 / $443.14 / $934.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.16 / $293.12 / $293.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.85 / $119.65 / $228.27