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New Hampshire rates for HCPCS A5503

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.82 / $22.82 / $27.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.01 / $22.16 / $27.16
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.68 / $31.68 / $31.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $45.26 / $53.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.09 / $28.09 / $29.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $21.27 / $31.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.85 / $34.85 / $107.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.89 / $22.39 / $33.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $21.32 / $32.60
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.82 / $36.10 / $45.95