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Pennsylvania 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
$26.52 / $42.10 / $518.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $26.52 / $43.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.97 / $54.08 / $54.08
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
$41.18 / $54.08 / $54.08
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 / $26.43 / $43.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.75 / $54.08 / $102.75
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.37 / $44.04 / $49.42
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $42.25 / $45.43
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.52 / $518.00 / $518.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $33.14 / $51.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.10 / $23.70 / $106.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $36.21
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $26.43 / $62.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.59 / $51.47 / $51.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.59 / $51.47 / $51.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.78 / $29.22 / $47.24