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LSO, Flexible, Off-the-Shelf

New Hampshire 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 $66 · 10th–90th $55$790%50%10th90th$66Professionalmedian $55 · 10th–90th $43$660%50%10th90th$55$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
$54.95
Median
$54.95
Typical High
$66.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$54.95
Typical High
$66.07
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$69.18
Typical High
$79.43
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$57.54
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$102.33
United
Setting
Facility
Modifier
Global
Typical Low
$27.54
Median
$44.67
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$54.95
Typical High
$79.43
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$104.71