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Oregon rates for HCPCS A5510

For Diabetics Only Direct Formed Compression Molded To Patients Foot Without External Heat Source Multiple-Density Insert(S) Prefabricated Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.74 / $32.74 / $32.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.90 / $23.90 / $32.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $34.25
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.29 / $39.29 / $79,999.20
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.29 / $39.29 / $39.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $35.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.90 / $2,250,000.00 / $2,400,000.00