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New Hampshire rates for HCPCS A5504

For Diabetics Only Modification (Including Fitting) Of Off-The- Shelf Depth-Inlay Shoe Or Custom-Molded Shoe With Wedge(S) Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

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
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
$27.14 / $27.14 / $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 / $29.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.85 / $34.85 / $107.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $21.32 / $28.80
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.82 / $36.10 / $45.95