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LSO, Flexible, Off-the-Shelf

Illinois 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 $34$4900%20%10th90th$65Professionalmedian $42 · 10th–90th $34$650%20%40%10th90th$42$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
$33.88
Median
$33.88
Typical High
$54.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$34.67
Typical High
$54.95
BCBS
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$251.19
Typical High
$575.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$41.69
Typical High
$41.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$93.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$72.44
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$97.72
Typical High
$125.89
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Molina
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$97.72
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$50.12
Typical High
$75.86