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LSO, Flexible, Off-the-Shelf

North Carolina 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 $69 · 10th–90th $37$1550%20%10th90th$69Professionalmedian $63 · 10th–90th $34$690%50%10th90th$63$0.1$1.0$10.0$100.0$1.0K

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
Facility
Modifier
Global
Typical Low
$52.48
Median
$69.18
Typical High
$69.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$69.18
Typical High
$69.18
BCBS
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$100.00
Typical High
$154.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$69.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$60.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$61.66
Medcost
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$51.29
Typical High
$66.07
Medcost
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$69.18
Typical High
$123.03
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$64.57
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$48.98
Typical High
$69.18
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58