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Diabetic Depth-Inlay Shoe, Off-the-Shelf, with Fitting

New Hampshire rates for HCPCS A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe

Rates data updated July 2026.

Facilitymedian $91 · 10th–90th $47$1100%20%40%10th90th$91Professionalmedian $58 · 10th–90th $39$780%20%10th90th$58$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$56.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$43.65
Typical High
$56.23
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$91.20
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$109.65
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$58.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$43.65
Typical High
$58.88
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$144.54
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$45.71
Typical High
$67.61
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$66.07
Typical High
$77.62
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$69.18
Typical High
$125.89