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LSO, Flexible, Off-the-Shelf

Michigan 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 $85 · 10th–90th $38$2190%10%20%10th90th$85Professionalmedian $54 · 10th–90th $34$720%20%40%10th90th$54$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
$38.02
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$38.02
Typical High
$53.70
BCBS
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$162.18
Typical High
$309.03
BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$56.23
CareSource
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$41.69
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
$57.54
Typical High
$102.33
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$190.55
Typical High
$213.80
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$67.61
Typical High
$97.72
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$83.18
Typical High
$112.20
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$54.95
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$47.86
Typical High
$72.44