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LSO, Flexible, Off-the-Shelf

New Jersey 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 $34 · 10th–90th $34$580%50%90th$34Professionalmedian $43 · 10th–90th $29$810%10%10th90th$43$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
$33.88
Median
$33.88
Typical High
$33.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$38.90
Typical High
$53.70
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
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$60.26
Typical High
$83.18
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$81.28
Typical High
$81.28
United
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$57.54
Typical High
$83.18
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$48.98
Typical High
$74.13