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South Dakota rates for HCPCS L0643

Lumbar-sacral orthosis (LSO), sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Facilitymedian $112 · 10th–90th $98–$2190%20%10th90th$112Professionalmedian $110 · 10th–90th $65–$1740%10%10th90th$110$20.0$50.0$100.0$200.0$500.0

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
$97.72 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $141.25 / $173.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $165.96 / $302.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $131.83 / $812.83
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $177.83
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $354.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $134.90 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $123.03 / $158.49
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88