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LSO, Flexible, Off-the-Shelf

Maryland 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 $52 · 10th–90th $34$580%20%10th90th$52Professionalmedian $38 · 10th–90th $28$690%20%10th90th$38$10.0$20.0$50.0$100.0$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
Professional
Modifier
Global
Typical Low
$27.54
Median
$32.36
Typical High
$58.88
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$54.95
Typical High
$54.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$60.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$57.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$57.54
Typical High
$91.20
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$57.54
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$48.98
Typical High
$77.62
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$53.70
Typical High
$54.95