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South Carolina rates for HCPCS A5503

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.17 / $36.17 / $36.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $36.17 / $39.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.29 / $37.82 / $52.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.27 / $27.64 / $33.58
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.28 / $37.36 / $71.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.00 / $31.00 / $31.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.71 / $29.71 / $3,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $26.10 / $33.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.21 / $20.74 / $31.10