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LSO, Flexible, Off-the-Shelf

Nebraska 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 $45$2750%10%10th90th$65Professionalmedian $39 · 10th–90th $35$600%20%40%10th90th$39$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
$46.77
Median
$46.77
Typical High
$46.77
Aetna
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$38.90
Typical High
$53.70
BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$60.26
Typical High
$60.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$93.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$89.13
Typical High
$204.17
Medica
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$83.18
Typical High
$275.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$50.12
Typical High
$91.20
Midlands
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$218.78
Midlands
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Midlands
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$204.17
Typical High
$218.78
United
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$64.57
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$48.98
Typical High
$75.86