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Utah rates for HCPCS A5513

For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

Facilitymedian $36 · 10th–90th $15–$540%20%40%10th90th$36Professionalmedian $35 · 10th–90th $16–$780%10%10th90th$35$20.0$50.0$100.0$200.0

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
$15.14 / $15.14 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $33.88 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $26.30 / $37.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $43.65 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $53.70 / $53.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $53.70 / $54.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $54.95 / $66.07
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.39 / $28.18 / $38.02
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $24.55 / $41.69