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Pennsylvania rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Facilitymedian $91 · 10th–90th $29–$1120%20%40%10th90th$91Professionalmedian $41 · 10th–90th $29–$710%20%10th90th$41$0.1$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
$28.84 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $38.02 / $69.18
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
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
$56.23 / $56.23 / $56.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $72.44
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $74.13 / $109.65
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $39.81 / $57.54
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $28.84 / $28.84
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $38.02 / $57.54
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $33.11 / $141.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $70.79 / $70.79
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $64.57 / $75.86
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $100.00 / $114.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $48.98 / $83.18