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LSO, Flexible, Off-the-Shelf

Montana 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 $56 · 10th–90th $41$1230%20%10th90th$56Professionalmedian $48 · 10th–90th $19$870%10%20%10th90th$48$10.0$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$19.05
Median
$34.67
Typical High
$120.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$69,183.10
Typical High
$91,201.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$87.10
Typical High
$87.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$87.10
Typical High
$87.10
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$48.98
Typical High
$85.11
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$48.98
Typical High
$85.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$64.57
Typical High
$112.20
Providence
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$79.43
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$47.86
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$44.67
Typical High
$69.18