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New Hampshire rates for HCPCS A5501

For Diabetics Only Fitting (Including Follow-Up) Custom Preparation And Supply Of Shoe Molded From Cast(S) Of Patients Foot (Custom Molded Shoe) Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.04 / $140.04 / $168.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.42 / $130.66 / $159.88
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.53 / $186.53 / $186.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.47 / $266.47 / $315.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.26 / $171.26 / $180.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.39 / $178.39 / $178.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.22 / $130.22 / $209.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.29 / $217.29 / $670.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.63 / $132.94 / $212.31
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.57 / $219.53 / $279.39