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Utah rates for HCPCS A5513

For Diabetics Only Multiple Density Insert Custom Molded From Model Of Patients Foot Total Contact With Patients 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.68 / $15.68 / $15.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.68 / $17.53 / $156.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $36.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $36.21 / $62.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $48.09 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.35 / $52.81 / $52.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.07 / $37.86 / $56.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.01 / $24.28 / $34.84