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LSO, Flexible, Off-the-Shelf

Arizona 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 $60 · 10th–90th $24$1740%10%10th90th$60Professionalmedian $43 · 10th–90th $23$830%20%10th90th$43$0.1$0.5$2.0$10.0$50.0$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
Facility
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$54.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$40.74
Typical High
$53.70
BCBS
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$93.33
Typical High
$177.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$87.10
Typical High
$173.78
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
$57.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$53.70
Typical High
$275.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$44.67
Typical High
$416.87
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$48.98
Typical High
$61.66
United
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$44.67
Typical High
$67.61