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South Dakota rates for HCPCS L0650

Lumbar-Sacral Orthosis Sagittal-Coronal Control With Rigid Anterior And Posterior Frame/Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Lateral Strength Provided By Rigid Lateral Frame/Panel(S) Produces Intracavitary Pressure To Reduce Load On Intervertebral Discs Includes Straps Closures May Include Padding Shoulder Straps Pendulous Abdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$739.37 / $739.37 / $739.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.60 / $791.01 / $870.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,279.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.13 / $1,031.33 / $1,276.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$825.28 / $1,245.72 / $3,899.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.30 / $840.35 / $1,499.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,279.55 / $1,306.08 / $1,744.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,285.69 / $1,422.23 / $2,690.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.22 / $991.08 / $1,053.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.69 / $735.31 / $1,119.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,139.97 / $1,139.97 / $1,139.97