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South Dakota rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, shoulder straps, pendulous abdomen design, custom fabricated

Facilitymedian $1,202 · 10th–90th $1,096–$1,9950%20%40%10th90th$1,202Professionalmedian $1,096 · 10th–90th $708–$2,1880%20%10th90th$1,096$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,096.48 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,862.09 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,584.89 / $3,019.95
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $1,071.52 / $7,943.28
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,737.80 / $1,737.80
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $1,778.28
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $2,884.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,621.81 / $2,137.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $1,071.52 / $1,778.28
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $1,548.82