Custom-fitted diabetic depth-inlay shoe with multi-density insert

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND SUPPLY OF OFF-THE-SHELF DEPTH-INLAY SHOE MANUFACTURED TO ACCOMMODATE MULTI-DENSITY INSERT(S), PER SHOE

Payers reporting HCPCS A5500

Payer pricing summary

Low

$17

Average

$103

Median

$96

High

$200

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +19 other terms	308	$91	$138	$144	104%	—	$41 – $697
2	UnitedHealthcare fee schedule · outpatient · +18 other terms	304	$91	$86	$17	20%	—	$1 – $247
3	Aetna fee schedule · outpatient · +19 other terms	288	$91	$101	$52	52%	—	$40 – $543
4	Blue Cross Blue Shield fee schedule · outpatient · +15 other terms	195	$92	$107	$43	40%	—	$0 – $317
5	WellCare fee schedule · outpatient · +8 other terms	191	$93	$96	$15	16%	—	$85 – $177
6	Devoted fee schedule · outpatient · +5 other terms	163	$91	$91	$2	2%	—	$87 – $111
7	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$93	$92	$3	4%	—	$91 – $112
8	Molina fee schedule · outpatient · +8 other terms	101	$111	$123	$48	39%	—	$67 – $237
9	Cigna fee schedule · outpatient · +14 other terms	92	$93	$101	$32	32%	—	$58 – $266
10	Anthem fee schedule · outpatient · +13 other terms	72	$89	$92	$8	8%	—	$87 – $118
11	Superior Healthplan fee schedule · outpatient	40	$95	$95	$0	0%	—	$89 – $95
12	Kaiser fee schedule · outpatient · +10 other terms	39	$89	$90	$3	4%	—	$87 – $107
13	Clover fee schedule · outpatient · +2 other terms	37	$91	$92	$4	4%	—	$89 – $109
14	Bcbs Tx fee schedule · outpatient · +2 other terms	31	$84	$85	$25	29%	—	$63 – $310
15	Optum fee schedule · outpatient · +8 other terms	25	$91	$105	$44	42%	—	$87 – $227
16	Caresource fee schedule · outpatient · +4 other terms	24	$91	$103	$20	19%	—	$91 – $136
17	Oscar fee schedule · outpatient · +6 other terms	24	$89	$91	$3	3%	—	$89 – $95
18	Medicare fee schedule · outpatient · +2 other terms	19	$87	$87	$1	1%	—	$85 – $89
19	Ambetter facility · fee schedule · outpatient · +5 other terms	18	$131	$142	$24	17%	—	$66 – $163
20	Amerihealth Caritas fee schedule · outpatient · +2 other terms	16	$109	$108	$2	2%	—	$103 – $109
21	Highmark fee schedule · outpatient · +6 other terms	14	$92	$95	$35	36%	—	$40 – $213
22	Wellmark fee schedule · both · +3 other terms	13	$87	$86	$4	4%	—	$65 – $87
23	Aetna Better Health fee schedule · outpatient · +4 other terms	12	$43	$62	$23	37%	—	$43 – $89
24	Bcbs Mn fee schedule · outpatient · +7 other terms	12	$79	$80	$21	26%	—	$40 – $97
25	Bcbs Nj fee schedule · outpatient · +3 other terms	12	$89	$192	$130	68%	—	$89 – $393

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