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Massachusetts rates for HCPCS A5514

For diabetics only, multiple density insert, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, 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
$24.51 / $24.51 / $24.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.64 / $24.51 / $40.46
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.38 / $154.05 / $256.88
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.52 / $41.82 / $52.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.06 / $69.83 / $89.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.21 / $41.60 / $41.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $35.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $35.59 / $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
$71.23 / $71.23 / $106.86
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
$19.60 / $26.98 / $52.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.60 / $31.36 / $54.08