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Foot, Molded Shoe, Plastazote, Custom Fitted

South Dakota rates for HCPCS L3253

Foot, molded shoe, Plastazote (or similar), custom fitted, each

Rates data updated July 2026.

Facilitymedian $34 · 10th–90th $23$710%10%20%10th90th$34Professionalmedian $28 · 10th–90th $18$470%10%10th90th$28$20.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$28.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$18.20
Median
$20.89
Typical High
$27.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$39.81
Typical High
$42.66
Medica
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$35.48
Typical High
$81.28
Medica
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$28.84
Typical High
$213.80
Midlands
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$48.98
Typical High
$63.10
Midlands
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$72.44
United
Setting
Facility
Modifier
Global
Typical Low
$22.39
Median
$22.91
Typical High
$32.36
United
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$28.84
Typical High
$38.90
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$218.78