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LSO, Flexible, Off-the-Shelf

Massachusetts 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 $123 · 10th–90th $43$1950%20%10th90th$123Professionalmedian $55 · 10th–90th $39$850%20%40%10th90th$55$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$42.66
Median
$42.66
Typical High
$42.66
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$42.66
Typical High
$107.15
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$69.18
Typical High
$281.84
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$61.66
Typical High
$93.33
BCBS
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$128.82
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$72.44
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$83.18
Health New England
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$69.18
Typical High
$281.84
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$61.66
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$53.70
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$54.95
Typical High
$74.13