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Utah rates for HCPCS A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.75 / $25.75 / $25.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.75 / $28.80 / $256.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.47 / $59.47 / $59.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $59.47 / $103.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $60.00 / $78.97
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.80 / $86.77 / $86.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.40 / $62.20 / $93.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.65 / $39.89 / $57.22