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South Dakota rates for HCPCS A5507

For Diabetics Only Not Otherwise Specified Modification (Including Fitting) Of Off-The-Shelf Depth-Inlay Shoe Or Custom- Molded Shoe Per Shoe (Special Coverage Instructions Apply. See Mcm: 2134)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.85 / $28.85 / $28.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.85 / $30.98 / $37.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $29.14 / $49.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.50 / $52.50 / $65.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $52.36 / $211.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.46 / $31.10 / $49.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.08 / $49.62 / $78.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.08 / $49.62 / $92.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.29 / $44.25 / $52.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.93 / $22.39 / $35.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.35 / $44.35 / $44.35