go back

Pennsylvania rates for HCPCS L0649

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), 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, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $224 · 10th–90th $100$3890%20%10th90th$224Professionalmedian $135 · 10th–90th $100$2040%20%10th90th$135$0.5$5.0$50.0$500.0$5.0K$50.0K

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
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$389.05
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$120.23
Typical High
$204.17
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$213.80
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$257.04
Typical High
$371.54
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$138.04
Typical High
$194.98
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$389.05
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$120.23
Typical High
$204.17
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$245.47
Typical High
$691.83
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$245.47
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$346.74
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$295.12