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South Carolina rates for HCPCS A5501

For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $169.82 / $234.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $269.15 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $309.03
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $177.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $239.88 / $436.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $95.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $177.83 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $131.83 / $190.55