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South Dakota rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Facilitymedian $58 · 10th–90th $50–$1120%20%10th90th$58Professionalmedian $56 · 10th–90th $33–$890%10%20%10th90th$56$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $50.12 / $56.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $89.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $85.11 / $154.88
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $64.57 / $416.87
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $93.33
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $181.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $69.18 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $64.57 / $85.11
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $81.28