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Orthopedic Footwear, Additional Charge for Split Size

South Dakota rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Rates data updated July 2026.

Facilitymedian $25 · 10th–90th $17$440%10%20%10th90th$25Professionalmedian $20 · 10th–90th $13$320%10%10th90th$20$10.0$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
$20.42
Median
$20.42
Typical High
$20.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$15.14
Typical High
$19.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$28.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$25.12
Typical High
$30.90
Medica
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$25.70
Typical High
$58.88
Medica
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$20.89
Typical High
$154.88
Midlands
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$35.48
Typical High
$45.71
Midlands
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$52.48
United
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$16.60
Typical High
$23.44
United
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$20.42
Typical High
$27.54
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21