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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
$25.12 / $25.12 / $25.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $52.48 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $72.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $60.26 / $79.43
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $77.62 / $134.90
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $63.10 / $95.50
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $91.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $91.20 / $109.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $45.71 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $39.81 / $57.54