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LSO, Flexible, Off-the-Shelf

Rhode Island 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 $138 · 10th–90th $55$2040%20%10th90th$138Professionalmedian $48 · 10th–90th $38$630%10%20%10th90th$48$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$42.66
Typical High
$58.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$144.54
Typical High
$204.17
BCBS
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$54.95
Typical High
$81.28
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
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$54.95
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$52.48
Typical High
$79.43