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LSO, Flexible, Off-the-Shelf

Connecticut 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 $58 · 10th–90th $37$650%20%10th90th$58Professionalmedian $48 · 10th–90th $34$740%10%20%10th90th$48$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$42.66
Typical High
$102.33
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$77.62
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$57.54
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$60.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$41.69
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$41.69
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$46.77
Typical High
$63.10
Health New England
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$44.67
Typical High
$58.88
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$48.98
Typical High
$69.18