go back

South Dakota rates for HCPCS A5514

For diabetics only, multiple density insert, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.47 / $34.47 / $34.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.25 / $36.97 / $45.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $59.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.63 / $62.63 / $78.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.10 / $62.48 / $253.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.78 / $40.46 / $58.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.46 / $59.49 / $113.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.46 / $61.81 / $141.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.47 / $54.08 / $71.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.01 / $27.44 / $44.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.00 / $53.00 / $53.00