go back

Pennsylvania rates for HCPCS L0486

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, two-piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated

Facilitymedian $2,884 · 10th–90th $871–$3,3880%20%10th90th$2,884Professionalmedian $1,122 · 10th–90th $871–$1,9050%20%10th90th$1,122$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $3,388.44 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,122.02 / $1,778.28
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $1,318.26
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $3,019.95 / $4,466.84
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,187.76 / $2,187.76
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,513.56 / $2,187.76
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,772.37 / $9,772.37 / $9,772.37
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $1,584.89 / $1,698.24
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $870.96
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,047.13 / $1,698.24
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $3,235.94 / $4,466.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $2,041.74
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $2,187.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,884.03 / $3,311.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,071.52 / $2,290.87