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Pennsylvania 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $41.69 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $33.11 / $58.88
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $50.12 / $54.95
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
$53.70 / $53.70 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $36.31
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $72.44 / $104.71
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $38.90 / $54.95
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $48.98 / $131.83
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $40.74 / $43.65
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $41.69 / $512.86
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $33.11 / $69.18
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $21.88 / $87.10
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $87.10
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $38.90 / $51.29
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $50.12 / $186.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $40.74 / $41.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $27.54 / $48.98