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LSO, Flexible, Off-the-Shelf

Florida 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 $54 · 10th–90th $44$1550%20%10th90th$54Professionalmedian $49 · 10th–90th $34$690%20%10th90th$49$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
$43.65
Median
$48.98
Typical High
$537.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$48.98
Typical High
$69.18
AvMed
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
AvMed
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$64.57
Typical High
$77.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$57.54
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$45.71
Typical High
$74.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$72.44
Typical High
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$47.86
Typical High
$70.79
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$48.98
Typical High
$64.57
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$72.44
Typical High
$72.44