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LSO, Flexible, Off-the-Shelf

Tennessee 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 $63 · 10th–90th $40$2820%20%10th90th$63Professionalmedian $39 · 10th–90th $35$680%20%40%10th90th$39$0.1$0.5$2.0$10.0$50.0$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
$36.31
Median
$39.81
Typical High
$63.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$38.02
Typical High
$60.26
BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$66.07
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$57.54
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$50.12
Typical High
$67.61
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$47.86
Typical High
$64.57