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Pennsylvania rates for HCPCS L1050

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.53 / $46.53 / $180.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.71 / $51.48 / $64.93
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
$86.09 / $113.06 / $113.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.68 / $71.68 / $93.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.33 / $52.33 / $82.14
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.30 / $93.80 / $178.22
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.34 / $76.34 / $76.34
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.53 / $46.53 / $180.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.71 / $51.48 / $64.93
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.50 / $127.90 / $184.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.68 / $71.68 / $93.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.33 / $52.33 / $140.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.83 / $107.61 / $107.61
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.83 / $107.61 / $115.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.31 / $125.07 / $150.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.60 / $56.41 / $94.01