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LSO, Flexible, Off-the-Shelf

Hawaii 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 $56 · 10th–90th $45$780%20%40%10th90th$56Professionalmedian $95 · 10th–90th $34$1000%20%40%10th90th$95$10.0$20.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$33.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$87.10
Typical High
$120.23
HMSA
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$100.00
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$95.50
Typical High
$134.90
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$69.18
Typical High
$123.03