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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 Multi- Density Insert(S) Per Shoe. (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.66 / $56.66 / $56.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.60 / $30.37 / $74.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.47 / $59.47 / $97.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.13 / $103.13 / $128.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.71 / $102.65 / $415.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.39 / $63.26 / $101.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.26 / $97.74 / $153.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.03 / $99.09 / $186.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.09 / $86.77 / $103.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.24 / $46.54 / $73.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.07 / $87.07 / $87.07