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LSO, Flexible, Off-the-Shelf

California 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 $52 · 10th–90th $42$1320%20%10th90th$52Professionalmedian $54 · 10th–90th $30$1200%20%10th90th$54$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$53.70
Typical High
$512.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$53.70
Typical High
$120.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$52.48
Typical High
$131.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$54.95
Typical High
$58.88
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$154.88
Typical High
$239.88
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$91.20
Typical High
$109.65
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
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$52.48
Typical High
$63.10
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$81.28
Typical High
$141.25
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Molina
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$38.90
Typical High
$91.20
Providence
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$57.54
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$53.70
Typical High
$89.13
United
Setting
Facility
Modifier
Global
Typical Low
$7.41
Median
$44.67
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$47.86
Typical High
$83.18