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LSO, Flexible, Off-the-Shelf

Maine 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 $76 · 10th–90th $52$870%20%10th90th$76Professionalmedian $55 · 10th–90th $35$600%50%10th90th$55$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$44.67
Typical High
$60.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$75.86
Typical High
$87.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
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
$57.54
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$66.07
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$44.67
Typical High
$60.26
United
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$44.67
Typical High
$57.54
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$54.95
Typical High
$81.28