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South Dakota rates for HCPCS L0457

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf

Facilitymedian $1,122 · 10th–90th $603–$2,0890%20%10th90th$1,122Professionalmedian $676 · 10th–90th $398–$1,0720%10%10th90th$676$200.0$500.0$1.0K$2.0K$5.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $2,089.30 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $602.56 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $870.96 / $1,071.52
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,023.29 / $1,819.70
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $812.83 / $5,011.87
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,096.48
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,096.48
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $831.76 / $1,000.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $758.58 / $977.24
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $954.99 / $954.99