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LSO, Flexible, Off-the-Shelf

Missouri 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 $65 · 10th–90th $38$1230%20%10th90th$65Professionalmedian $51 · 10th–90th $35$1000%20%10th90th$51$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
$43.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$39.81
Typical High
$120.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$223.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$54.95
Typical High
$95.50
BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$64.57
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$87.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$57.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$60.26
Typical High
$275.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$50.12
Typical High
$416.87
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$52.48
Typical High
$67.61
United
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$48.98
Typical High
$67.61