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New Hampshire rates for HCPCS A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.68 / $46.68 / $56.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.80 / $43.57 / $53.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.20 / $62.20 / $62.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $88.85 / $105.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.66 / $57.66 / $60.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.47 / $59.47 / $59.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $43.41 / $69.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $223.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.55 / $44.32 / $61.04
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.72 / $77.70 / $117.36