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Oregon rates for HCPCS A5503

For Diabetics Only Modification (Including Fitting) Of Off-The- Shelf Depth-Inlay Shoe Or Custom-Molded Shoe With Roller Or Rigid Rocker Bottom Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $32.57 / $123.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $29.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.95 / $45.26 / $105.92
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $38.40 / $45.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.86 / $40.72 / $45.26
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $44.25 / $52.05
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.63 / $45.26 / $45.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.75 / $38.40 / $49.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $39.57 / $49.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.01 / $71.06 / $158.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.92 / $49.79 / $49.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.99 / $30.99 / $33.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.11 / $19.19 / $38.75