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LSO, Flexible, Off-the-Shelf

Oklahoma 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 $44 · 10th–90th $34$1170%20%10th90th$44Professionalmedian $48 · 10th–90th $34$660%20%10th90th$48$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
$35.48
Typical High
$35.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$36.31
Typical High
$53.70
BCBS
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
BCBS
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$66.07
Typical High
$66.07
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
$72.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$60.26
Typical High
$275.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$48.98
Typical High
$97.72
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$61.66
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$64.57