go back

South Dakota rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, 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 padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Facilitymedian $282 · 10th–90th $245–$5500%20%10th90th$282Professionalmedian $275 · 10th–90th $162–$4370%10%20%10th90th$275$100.0$200.0$500.0$1.0K$2.0K

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
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $245.47 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $436.52
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $416.87 / $758.58
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $331.13 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $891.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $346.74 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $316.23 / $398.11
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $398.11