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Virginia 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
$33.42 / $33.42 / $36.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.25 / $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
$30.75 / $30.75 / $38.44
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.97 / $35.97 / $36.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $35.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $25.99 / $36.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.56 / $48.67 / $64.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.42 / $36.72 / $62.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.56 / $77.20 / $90.07
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.65 / $44.56 / $77.16
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.65 / $44.56 / $77.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.52 / $26.98 / $43.56