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South Dakota rates for HCPCS L0976

Lumbar-sacral orthosis (LSO), full corset

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $125.89 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $263.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $218.78 / $426.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $128.82 / $1,148.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $218.78 / $218.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $407.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $229.09 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $114.82 / $194.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98