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Pennsylvania rates for HCPCS A5514

For Diabetics Only Multiple Density Insert Made By Direct Carving With Cam Technology From A Rectified Cad Model Created From A Digitized Scan Of The Patient 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 / $26.52 / $42.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.05 / $33.14 / $43.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.39 / $28.39 / $28.39
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
$35.60 / $35.60 / $35.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $25.99 / $43.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.75 / $54.08 / $102.75
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.57 / $42.25 / $45.97
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.52 / $42.10 / $158.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.44 / $33.14 / $43.26
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.60 / $106.50 / $106.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $35.60
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $25.99 / $62.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.02 / $51.47 / $51.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.02 / $51.47 / $51.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.56 / $28.31 / $52.27