go back

Pennsylvania rates for HCPCS L1040

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, lumbar or lumbar rib pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.60 / $38.60 / $149.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.40 / $44.35 / $57.60
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.42 / $93.80 / $93.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.78 / $66.78 / $87.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.75 / $48.75 / $76.95
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.86 / $87.89 / $166.99
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.84 / $66.84 / $66.84
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.60 / $38.60 / $149.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.40 / $45.17 / $61.30
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.50 / $119.90 / $173.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.78 / $66.78 / $87.89
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.75 / $48.75 / $123.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.04 / $89.28 / $89.28
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.04 / $89.28 / $101.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.60 / $117.18 / $140.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.75 / $47.26 / $81.94