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Utah rates for HCPCS A5510

For Diabetics Only Direct Formed Compression Molded To Patients Foot Without External Heat Source Multiple-Density Insert(S) Prefabricated Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.74 / $32.74 / $32.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.90 / $32.74 / $32.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $60.00