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Hawaii 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
$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
$31.98 / $49.79 / $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
Professional
Modifier
Low / Median / High Price
$23.90 / $34.57 / $49.79
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.28 / $35.27 / $43.06