go back

Massachusetts rates for HCPCS A5503

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.01 / $19.01 / $19.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.01 / $19.01 / $33.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.47 / $134.11 / $214.99
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.80 / $34.45 / $46.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.02 / $56.79 / $73.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.87 / $30.16 / $30.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $29.14 / $52.50
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
$34.85 / $34.85 / $36.59
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.33 / $36.33 / $36.33
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.88 / $214.99 / $214.99
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.16 / $21.32 / $55.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.59 / $26.10 / $31.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.70 / $22.13 / $45.26