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California rates for HCPCS A5504

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.32 / $13.50 / $123.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $19.00 / $123.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.01 / $59.35 / $143.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.97 / $27.14 / $42.09
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.23 / $65.38 / $100.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.09 / $80.16 / $137.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $34.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $52.50
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.12 / $25.34 / $49.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.16 / $31.68 / $68.80
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.88 / $214.99 / $214.99
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.39 / $225.39 / $339.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.78 / $92.78 / $92.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $38.56 / $45.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $43.06
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.65 / $80.65 / $80.65
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.12 / $35.90 / $36.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.34 / $21.32 / $49.79