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Pennsylvania rates for HCPCS A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $69.18 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $53.70 / $104.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $70.79 / $89.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $67.61 / $91.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $58.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $117.49 / $173.78
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $63.10 / $91.20
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $63.10 / $213.80
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $67.61 / $74.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $69.18 / $302.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $54.95 / $107.15
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $35.48 / $144.54
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $29.51 / $144.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $63.10 / $85.11
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $63.10 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $63.10 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $45.71 / $79.43