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LSO, Flexible, Off-the-Shelf

Indiana 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 $55 · 10th–90th $33$890%50%10th90th$55Professionalmedian $43 · 10th–90th $30$740%20%10th90th$43$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
$33.11
Median
$33.11
Typical High
$33.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$33.88
Typical High
$60.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$54.95
Typical High
$95.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$54.95
Typical High
$85.11
CareSource
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$83.18
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$57.54
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$44.67
Typical High
$67.61
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$48.98
Typical High
$69.18