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Pennsylvania rates for HCPCS L0638

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated

Facilitymedian $1,950 · 10th–90th $631–$2,4550%20%10th90th$1,950Professionalmedian $794 · 10th–90th $631–$1,4450%20%10th90th$794$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
$630.96 / $2,454.71 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $776.25 / $1,174.90
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
$1,548.82 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $1,122.02
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $2,089.30 / $3,019.95
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,584.89
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,096.48 / $1,584.89
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $758.58 / $1,096.48
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $2,187.76 / $3,090.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,479.11
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $1,949.84 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $776.25 / $1,584.89