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LSO, Flexible, Off-the-Shelf

Iowa 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 $74 · 10th–90th $45$2090%10%10th90th$74Professionalmedian $50 · 10th–90th $30$1000%20%10th90th$50$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
$38.02
Median
$50.12
Typical High
$74.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$45.71
Typical High
$69.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$93.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$89.13
Typical High
$107.15
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$97.72
Typical High
$104.71
Medica
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$107.15
Typical High
$275.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$61.66
Typical High
$147.91
Midlands
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$100.00
Typical High
$107.15
Midlands
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Midlands
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$169.82
Typical High
$169.82
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$77.62
Typical High
$117.49
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$64.57
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$89.13
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$81.28
Typical High
$81.28