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Pennsylvania rates for HCPCS L0650

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

Rates data updated July 2026.

Facilitymedian $955 · 10th–90th $398$1,5490%20%10th90th$955Professionalmedian $603 · 10th–90th $398$1,0000%20%10th90th$603$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
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$1,548.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$562.34
Typical High
$870.96
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$812.83
Typical High
$831.76
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$588.84
Typical High
$794.33
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
$794.33
Median
$794.33
Typical High
$794.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$1,288.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$588.84
Typical High
$870.96
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,071.52
Typical High
$1,548.82
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$812.83
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$562.34
Typical High
$812.83
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$630.96
Typical High
$870.96
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$588.84
Typical High
$588.84
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$1,548.82
Typical High
$4,073.80
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$549.54
Typical High
$1,000.00
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$1,148.15
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$912.01
Typical High
$2,570.40
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$933.25
United
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$1,445.44
Typical High
$1,445.44
United
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$645.65
Typical High
$1,096.48