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Massachusetts rates for HCPCS A5501

For Diabetics Only Fitting (Including Follow-Up) Custom Preparation And Supply Of Shoe Molded From Cast(S) Of Patients Foot (Custom Molded Shoe) Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.42 / $116.42 / $116.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.42 / $116.42 / $200.25
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.41 / $789.85 / $1,265.73
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.65 / $204.85 / $270.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.95 / $344.10 / $443.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.48 / $182.75 / $182.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $490.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $178.39 / $309.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.29 / $217.29 / $228.15
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.51 / $213.64 / $213.64
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.92 / $1,265.73 / $1,265.73
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.09 / $142.43 / $362.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.09 / $142.43 / $266.47