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New Hampshire rates for HCPCS A5514

For diabetics only, multiple density insert, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, total contact with patient's 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
$31.19 / $31.19 / $37.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.51 / $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
$30.75 / $30.75 / $30.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $35.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $25.99 / $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 / $37.03
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.89 / $46.08 / $58.65