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.
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
Low
$91
Average
$133
Median
$140
High
$188
Each hospital's average Medical Mutual rate, under the methodology and billing class chosen below.
31 hospitals; the 90th percentile is 1.8× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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33 hospital rates
iThe hospitals that file a Medical Mutual rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 2 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 3 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 4 | Dupont Hospital LLC Wayne, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 5 | Dupont Hospital LLC Wayne, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 6 | GROVE CITY MEDICAL CENTER GROVE CITY, PA fee schedule · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 7 | JEFFERSON REGIONAL MEDICAL CENTER JEFFERSON HILLS, PA fee schedule · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 8 | Mayo Clinic Arizona Phoenix, AZ professional · percent of total billed charges · outpatientfrom % of charges | 3 | $104 | $108 | $12 | 11% | — | $96 – $125 |
| 9 | Mayo Clinic Health System Mankato 56001-4752 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 10 | Mayo Clinic Health System Lake City 55041-1143 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 11 | Mayo Clinic Health System Saint James 56081-5550 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 12 | Mayo Clinic Health System Fairmont 56031-4575 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 13 | Mayo Clinic Health System St, NE professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 14 | Mayo Clinic Health System Owatonna 55060-5503 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 15 | Mayo Clinic Health System Waseca 56093-2811 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 16 | Mayo Clinic Health System Cannon Falls 55009-5003 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 17 | Mayo Clinic Health System Red Wing 55066-2848 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 18 | SAINT VINCENT HEALTH CENTER ERIE, PA fee schedule · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 19 | St. Joseph Health System, LLC Wayne, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 20 | St. Joseph Health System, LLC Wayne, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 21 | University Hospitals Health System Chardon, OH facility · fee schedule · outpatient | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 22 | University Hospitals Health System Ravenna, OH facility · fee schedule · outpatient | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 23 | University Hospitals Health System Chardon, OH facility · fee schedule · outpatient | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 24 | University Hospitals Health System Beachwood, OH facility · fee schedule · outpatient | 5 | $143 | $130 | $20 | 16% | — | $91 – $143 |
| 25 | University Hospitals Health System Concord Township, OH facility · fee schedule · outpatient | 5 | $136 | $127 | $18 | 14% | — | $91 – $136 |
← Payers reporting HCPCS A5500 · Snapshot 20261111T120946Z-9134e7f7