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Virginia rates for HCPCS A5505

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with metatarsal bar, 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
$27.87 / $27.87 / $34.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.50 / $28.50 / $28.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.81 / $20.81 / $29.36
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
$26.16 / $33.97 / $61.95
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.16 / $33.97 / $61.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.80 / $21.32 / $33.53