For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of Shore A 35 durometer or 3/16 inch material of Shore A 40 durometer (or higher), prefabricated, each
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $26.34 | $26.34 | $26.34 | |
Aetna
| Professional | $11.75 | $26.27 | $26.34 | |
BCBS
| Professional | $26.97 | $26.97 | $26.97 | |
Cigna
| Facility | $24.26 | $24.26 | $24.26 | |
Cigna
| Professional | $17.71 | $24.26 | $34.49 | |
United
| Professional | $10.85 | $17.71 | $27.21 |