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, 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 SHAPIN
Low
$33
Average
$156
Median
$91
High
$882
Each hospital's average First Health rate, under the methodology and billing class chosen below.
21 hospitals; the 90th percentile is 6.8× 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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36 hospital rates
iThe hospitals that file a First Health 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 | Bexar County Hospital District San Antonio, TX fee schedule · outpatient | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 2 | Bluffton Health System LLC Bluffton, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 3 | Bluffton Health System LLC Bluffton, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 4 | Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 5 | Davis Medical Center Elkins, WV professional · fee schedule · both | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 6 | Dukes Health System LLC Peru, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 7 | Dukes Health System LLC Peru, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 8 | FHN Memorial Hospital Freeport, IL percent of total billed charges · outpatientfrom % of charges | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 9 | GLENCOE REGIONAL HEALTH SERVICES Glencoe, MN professional · fee schedule · outpatient | 1 | $404 | $404 | — | — | — | $404 – $404 |
| 10 | Lutheran Musculoskeletal Center LLC Fort Wayne, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 11 | Lutheran Musculoskeletal Center LLC Fort Wayne, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 12 | Marshfield Medical Center - Dickinson Iron Mountain, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 13 | Marshfield Medical Center - Dickinson Iron Mountain, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 14 | Medical Center of the Rockies Loveland, CO percent of total billed charges · inpatientfrom % of charges | 1 | $217 | $217 | $31 | 14% | — | $187 – $248 |
| 15 | Medical Center of the Rockies Loveland, CO percent of total billed charges · outpatientfrom % of charges | 1 | $217 | $217 | $31 | 14% | — | $187 – $248 |
| 16 | Poudre Valley Health Care, Inc Fort Collins, CO percent of total billed charges · inpatientfrom % of charges | 1 | $217 | $217 | $31 | 14% | — | $187 – $248 |
| 17 | Poudre Valley Health Care, Inc Fort Collins, CO percent of total billed charges · outpatientfrom % of charges | 1 | $217 | $217 | $31 | 14% | — | $187 – $248 |
| 18 | Shannon Medical Center San Angelo, TX facility · percent of total billed charges · inpatientfrom % of charges | 1 | $122 | $122 | — | — | — | $122 – $122 |
| 19 | Shannon Medical Center San Angelo, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $122 | $122 | — | — | — | $122 – $122 |
| 20 | Shannon Medical Center Big Spring Big Spring, TX facility · percent of total billed charges · inpatientfrom % of charges | 1 | $122 | $122 | — | — | — | $122 – $122 |
| 21 | Shannon Medical Center Big Spring Big Spring, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $122 | $122 | — | — | — | $122 – $122 |
| 22 | Shannon River Crest Hospital San Angelo, TX facility · percent of total billed charges · inpatientfrom % of charges | 1 | $122 | $122 | — | — | — | $122 – $122 |
| 23 | Shannon River Crest Hospital San Angelo, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $122 | $122 | — | — | — | $122 – $122 |
| 24 | St. Joseph Health System, LLC Wayne, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 25 | St. Joseph Health System, LLC Wayne, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $86 | $86 | — | — | — | $86 – $86 |
← Payers reporting HCPCS A5513 · Snapshot 20261111T120946Z-9134e7f7