go back

LSO, Flexible, Off-the-Shelf

North Dakota 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 $74 · 10th–90th $50$1450%20%40%10th90th$74Professionalmedian $69 · 10th–90th $50$760%20%10th90th$69$10.0$20.0$50.0$100.0$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
$74.13
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$53.70
Typical High
$107.15
BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$69.18
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$72.44
Typical High
$89.13
Medica
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$74.13
Typical High
$275.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$44.67
Typical High
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$61.66
Typical High
$83.18