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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 (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $11.45 / $11.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.45 / $24.11 / $123.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $29.14 / $52.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.53 / $60.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.57 / $44.25 / $44.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.20 / $31.68 / $47.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.59 / $30.38 / $30.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.50 / $19.19 / $25.45