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New Hampshire rates for HCPCS A5513

For Diabetics Only Multiple Density Insert Custom Molded From Model Of Patients Foot Total Contact With Patients 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
$28.43 / $28.43 / $34.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.53 / $26.52 / $32.45
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $37.86 / $37.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $54.08 / $64.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.94 / $34.94 / $36.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $36.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $26.43 / $42.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.09 / $44.09 / $136.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $26.98 / $32.04
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.50 / $47.56 / $71.44