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Hawaii 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
Professional
Modifier
Low / Median / High Price
$19.30 / $19.30 / $19.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.57 / $34.57 / $34.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $31.98 / $49.79
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $47.39 / $47.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $45.26 / $63.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.99 / $30.99 / $33.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $34.57 / $49.79
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.50 / $35.27 / $43.06