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Iowa 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
Facility
Modifier
Low / Median / High Price
$28.85 / $28.85 / $31.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $28.76 / $37.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $49.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.45 / $52.50 / $65.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.56 / $49.93 / $53.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $58.13 / $211.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.79 / $28.28 / $58.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.87 / $49.79 / $61.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $58.13 / $90.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.79 / $21.74 / $53.61
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.35 / $44.35 / $44.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.04 / $44.35 / $44.35