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LSO, Flexible, Off-the-Shelf

Oregon 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 $42 · 10th–90th $28$810%20%10th90th$42Professionalmedian $42 · 10th–90th $29$780%20%10th90th$42$0.1$1.0$10.0$100.0$1.0K

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
Professional
Modifier
Global
Typical Low
$29.51
Median
$36.31
Typical High
$56.23
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
$41.69
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$61.66
Typical High
$74.13
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$74.13
Typical High
$91.20
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$72.44
Typical High
$77.62
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$41.69
Typical High
$79.43
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$83.18
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$43.65
Typical High
$107.15
Providence
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$41.69
Typical High
$79.43
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$79.43
Typical High
$154.88
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$31.62
Typical High
$43.65
United
Setting
Facility
Modifier
Global
Typical Low
$0.07
Median
$44.67
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$44.67
Typical High
$69.18