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Utah rates for HCPCS A5503

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe

Facilitymedian $29 · 10th–90th $11–$460%20%40%10th90th$29Professionalmedian $31 · 10th–90th $11–$1950%10%20%10th90th$31$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $28.84 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $28.84 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.38 / $21.38 / $30.20
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $35.48 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $45.71 / $45.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $50.12
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $45.71 / $45.71
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $45.71 / $54.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $22.91 / $30.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.85 / $19.05 / $34.67