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South Dakota rates for HCPCS L0625

Lumbar orthosis (LO), flexible, provides lumbar support, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.24 / $33.24 / $33.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.67 / $33.24 / $37.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.15 / $42.22 / $59.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.25 / $47.72 / $59.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.92 / $62.78 / $181.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.79 / $40.85 / $70.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.25 / $60.40 / $80.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.25 / $63.94 / $124.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.65 / $45.96 / $56.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.13 / $33.54 / $55.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.78 / $52.78 / $52.78