go back

Diabetic Shoe Modification, Wedge

New York 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

Rates data updated July 2026.

How much does Diabetic Shoe Modification, Wedge cost?

$27.54

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $27.54 for this service. The price depends on where it is billed: about $27.54 from a physician practice, and about $33.11 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$27.54$25.70 to $42.66
FacilityA hospital or hospital-owned outpatient department$33.11$26.92 to $45.71

How much rates vary

Facilitymedian $33 · 10th to 90th $19 to $69Professionalmedian $28 · 10th to 90th $19 to $68
$10$100$1K$10Kfacility $33professional $28

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$27.54
Typical High
$51.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$27.54
Typical High
$42.66
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$91.20
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$75.86
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$37.15
Typical High
$37.15
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$37.15
Typical High
$37.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$61.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$21.38
Typical High
$30.90
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$75.86
Typical High
$177.83
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$48.98
Typical High
$87.10
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$34.67
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$24.55
Typical High
$33.11
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$44.67
Typical High
$51.29
United
Setting
Facility
Modifier
Global
Typical Low
$17.78
Median
$30.90
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$29.51
Typical High
$75.86
Univera
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$30.20
Typical High
$34.67
Univera
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$24.55
Typical High
$33.11

Where New York sits

The same service costs 2.2 times more in Kansas than in Colorado. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New York· 43rd of 51

$27.54

KS $46.77CO $21.38

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.