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LSO, Flexible, Off-the-Shelf

Kentucky 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 $48 · 10th–90th $38$890%20%10th90th$48Professionalmedian $36 · 10th–90th $29$580%20%10th90th$36$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
$38.02
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$37.15
Typical High
$54.95
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$64.57
Typical High
$69.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$29.51
Typical High
$54.95
CareSource
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$85.11
Typical High
$112.20
CareSource
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$79.43
Typical High
$102.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$89.13
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$61.66
Typical High
$295.12
Molina
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$70.79
Typical High
$91.20
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$47.86
Typical High
$64.57