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Utah rates for HCPCS A5501

For Diabetics Only Fitting (Including Follow-Up) Custom Preparation And Supply Of Shoe Molded From Cast(S) Of Patients Foot (Custom Molded Shoe) Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.23 / $77.23 / $77.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.23 / $78.67 / $768.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $178.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $178.39 / $309.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $236.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.33 / $260.22 / $260.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.18 / $186.53 / $279.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.92 / $119.65 / $171.64