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LSO, Flexible, Off-the-Shelf

Georgia 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 $65 · 10th–90th $38$2400%10%20%10th90th$65Professionalmedian $54 · 10th–90th $34$930%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
$38.02
Median
$38.02
Typical High
$102.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$38.02
Typical High
$69.18
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$154.88
Typical High
$239.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$85.11
Typical High
$112.20
CareSource
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
CareSource
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$53.70
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
$87.10
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$64.57
Typical High
$186.21
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$50.12
Typical High
$75.86