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LSO, Flexible, Off-the-Shelf

Washington, DC 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 $28 · 10th–90th $28$1200%50%90th$28Professionalmedian $28 · 10th–90th $28$520%50%90th$28$50.0$100.0

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
$27.54
Median
$27.54
Typical High
$40.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$27.54
Typical High
$47.86
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$54.95
Typical High
$54.95
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
$61.66
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$48.98
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$48.98
Typical High
$63.10