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Pennsylvania rates for HCPCS A5505

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with metatarsal bar, per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.16 / $22.16 / $35.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.10 / $27.70 / $36.17
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.45 / $45.26 / $45.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.50 / $28.50 / $28.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.81 / $20.81 / $33.58
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.64 / $45.26 / $85.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.16 / $22.16 / $35.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.30 / $27.70 / $39.57
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $61.70 / $89.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.50 / $28.50 / $28.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.81 / $20.81 / $52.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.18 / $43.06 / $43.06
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.18 / $43.06 / $43.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.37 / $23.09 / $35.63