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

Wisconsin 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 $74$1820%20%40%10th90th$91Professionalmedian $85 · 10th–90th $42$1480%10%10th90th$85$50.0$100.0$200.0$500.0

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
$51.29
Median
$51.29
Typical High
$51.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$51.29
Typical High
$77.62
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$147.91
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$85.11
Typical High
$102.33
CareSource
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$281.84
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$131.83
Typical High
$169.82
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$77.62
Typical High
$128.82
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$147.91
Medica
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$89.13
Typical High
$416.87
Medica
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$58.88
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$50.12
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Network Health
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$102.33
Typical High
$177.83
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$77.62
Typical High
$128.82
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$89.13
Quartz
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$134.90
Typical High
$239.88
Quartz
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$181.97
Typical High
$426.58
Quartz
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$134.90
Typical High
$446.68
Security Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Security Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
United
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$63.10
Typical High
$91.20
United
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$46.77
Typical High
$87.10