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South Dakota rates for HCPCS L0636

Lumbar-sacral orthosis (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated

Facilitymedian $1,349 · 10th–90th $1,122–$2,2910%20%40%10th90th$1,349Professionalmedian $1,288 · 10th–90th $724–$2,3440%10%10th90th$1,288$1.0K$2.0K$5.0K$10.0K

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
$1,122.02 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,122.02 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,905.46 / $2,344.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,862.09 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,230.27 / $10,964.78
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,187.76 / $2,187.76
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,238.72 / $2,238.72
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $1,819.70 / $3,388.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,862.09 / $2,511.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $1,230.27 / $1,905.46
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84