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Washington rates for HCPCS A5507

For Diabetics Only Not Otherwise Specified Modification (Including Fitting) Of Off-The-Shelf Depth-Inlay Shoe Or Custom- Molded Shoe Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.17 / $57.14 / $59.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.46 / $25.17 / $61.33
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.57 / $86.29 / $211.82
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.71 / $39.61 / $225.39
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 / $33.58
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.59 / $43.21 / $79.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.92 / $45.26 / $85.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.02 / $33.36 / $36.69
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $44.25 / $45.26
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.03 / $45.26 / $45.26
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.61 / $39.57 / $86.29
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.61 / $42.92 / $65.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.06 / $44.25 / $44.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.38 / $38.47 / $49.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.19 / $22.39 / $38.75
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.79 / $28.79 / $28.79