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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
$22.91 / $22.91 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $33.11 / $100.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $52.48 / $257.04
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $41.69 / $79.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $70.79 / $93.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $37.15 / $37.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $42.66
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $47.86 / $72.44
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $107.15
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $35.48 / $43.65
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $52.48 / $257.04
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $44.67 / $83.18
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $40.74 / $47.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $32.36 / $38.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $37.15 / $51.29