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LSO, Flexible, Off-the-Shelf

New York 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 $58 · 10th–90th $34$1000%20%10th90th$58Professionalmedian $55 · 10th–90th $34$1120%20%10th90th$55$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$33.88
Median
$42.66
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$42.66
Typical High
$69.18
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$114.82
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$147.91
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$72.44
Typical High
$72.44
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$64.57
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$93.33
Typical High
$218.78
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$60.26
Typical High
$109.65
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$69.18
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$60.26
Typical High
$66.07
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$53.70
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$52.48
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$53.70
Typical High
$95.50
Univera
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$69.18
Univera
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$60.26
Typical High
$66.07