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LSO, Flexible, Off-the-Shelf

Minnesota 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 $141 · 10th–90th $62$5130%10%20%10th90th$141Professionalmedian $79 · 10th–90th $50$830%20%40%10th90th$79$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
$50.12
Median
$50.12
Typical High
$50.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$50.12
Typical High
$74.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$83.18
Typical High
$125.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$83.18
Typical High
$83.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$234.42
Typical High
$645.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$81.28
Typical High
$91.20
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$257.04
Typical High
$512.86
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$97.72
Medica
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$61.66
Typical High
$275.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$0.72
Median
$44.67
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$52.48
Typical High
$102.33