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South Dakota rates for HCPCS L3250

Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each

Facilitymedian $204 · 10th–90th $166–$4170%20%10th90th$204Professionalmedian $200 · 10th–90th $120–$5010%10%10th90th$200$100.0$200.0$500.0$1.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $165.96 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $501.19
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $257.04 / $602.56
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $213.80 / $1,548.82
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $354.81 / $467.74
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $208.93 / $281.84
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78