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LSO, Flexible, Off-the-Shelf

Idaho 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 $58 · 10th–90th $33$1100%10%20%10th90th$58Professionalmedian $45 · 10th–90th $28$910%10%20%10th90th$45$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$33.11
Typical High
$53.70
BCBS
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$85.11
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$91.20
Typical High
$91.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$61.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$57.54
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$54.95
Typical High
$91.20
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$40.74
Typical High
$51.29
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$70.79
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$40.74
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$57.54
Select Health
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$43.65
Typical High
$128.82
Select Health
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$56.23
Typical High
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$0.07
Median
$48.98
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$44.67
Typical High
$67.61