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South Dakota rates for HCPCS A5506

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with off-set heel(s), per shoe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $28.18 / $38.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $50.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $66.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $48.98 / $85.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $28.18 / $223.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $50.12 / $50.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $79.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $45.71 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $28.18 / $45.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67