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Massachusetts rates for HCPCS A5505

For Diabetics Only Modification (Including Fitting) Of Off-The- Shelf Depth-Inlay Shoe Or Custom-Molded Shoe With Metatarsal Bar Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

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
$28.50 / $28.50 / $28.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.81 / $28.50 / $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
Professional
Modifier
Low / Median / High Price
$15.09 / $21.32 / $45.26