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Alaska 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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.06 / $43.06 / $43.06
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 / $21.27
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $11.45 / $11.45
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.00 / $43.00 / $67.89
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.57 / $39.57 / $44.25
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $44.25 / $88.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $11.45 / $35.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.10 / $35.53 / $88.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.32 / $40.86 / $74.61