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Massachusetts 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
$23.63 / $23.63 / $23.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.53 / $23.63 / $45.29
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.38 / $160.28 / $256.88
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.28 / $41.58 / $54.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.04 / $69.83 / $89.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.42 / $37.09 / $37.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $36.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $36.21 / $62.63
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
$44.09 / $44.09 / $46.29
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.86 / $106.86 / $130.08
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.61 / $43.36 / $43.36
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.78 / $256.88 / $256.88
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.12 / $28.91 / $73.63
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.86 / $40.50 / $49.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.12 / $28.91 / $54.08