go back

Virginia rates for HCPCS A5513

For diabetics only, multiple density insert, custom molded from model of patient's foot, 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
$26.07 / $33.42 / $33.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.54 / $33.42 / $41.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $54.08 / $57.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.94 / $34.94 / $42.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.19 / $30.19 / $36.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $36.21 / $36.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $26.43 / $37.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.56 / $54.08 / $64.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.68 / $35.65 / $61.75
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.95 / $71.03 / $90.07
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.65 / $42.33 / $73.93
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.65 / $42.79 / $73.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.28 / $26.98 / $42.78