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Virginia 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
$27.18 / $27.18 / $30.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.96 / $27.18 / $33.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.26 / $45.26 / $48.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.09 / $28.09 / $35.11
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.74 / $23.74 / $30.98
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 / $21.27 / $30.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.95 / $45.26 / $54.31
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $28.99 / $51.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.00 / $59.42 / $75.36
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.91 / $33.97 / $61.96
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.16 / $33.97 / $61.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.37 / $26.10 / $33.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.80 / $21.32 / $33.53