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LSO, Flexible, Off-the-Shelf

Alaska rates for HCPCS L0628

Lumbar-sacral orthosis (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $29 · 10th–90th $29$910%50%90th$29Professionalmedian $54 · 10th–90th $33$1070%10%20%10th90th$54$50.0$100.0$200.0

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
Professional
Modifier
Global
Typical Low
$23.44
Median
$42.66
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$102.33
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$91.20
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$91.20
Typical High
$144.54
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$91.20
Typical High
$95.50
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$91.20
Typical High
$95.50
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$81.28
Providence
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$60.26
Typical High
$72.44
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$47.86
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$74.13
Typical High
$245.47