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Pennsylvania rates for HCPCS L1250

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior ASIS pad

Facilitymedian $110 · 10th–90th $40$1550%20%10th90th$110Professionalmedian $48 · 10th–90th $39$950%20%40%10th90th$48$0.1$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
$39.81 / $154.88 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $46.77 / $66.07
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
$97.72 / $97.72 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $83.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $61.66
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $109.65 / $158.49
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $64.57 / $100.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $72.44 / $72.44
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $39.81
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $46.77 / $58.88
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $112.20 / $162.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $93.33 / $269.15
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $72.44 / $95.50
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $109.65 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $48.98 / $87.10