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LSO, Flexible, Off-the-Shelf

Delaware 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 $48 · 10th–90th $0$580%20%40%10th90th$48Professionalmedian $32 · 10th–90th $30$1070%20%40%10th90th$32$0.1$0.5$2.0$10.0$50.0

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
$29.51
Median
$29.51
Typical High
$107.15
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
$58.88
United
Setting
Facility
Modifier
Global
Typical Low
$0.07
Median
$44.67
Typical High
$47.86
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$50.12
Typical High
$74.13