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South Dakota rates for HCPCS A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $56.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $128.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $97.72 / $165.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $61.66 / $446.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $97.72 / $97.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $158.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $89.13 / $117.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $61.66 / $89.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10