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LSO, Flexible, Off-the-Shelf

Texas 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 $62 · 10th–90th $34$2820%10%20%10th90th$62Professionalmedian $40 · 10th–90th $32$600%20%10th90th$40$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
Facility
Modifier
Global
Typical Low
$33.88
Median
$34.67
Typical High
$43.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$38.02
Typical High
$56.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$51.29
Christus
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$79.43
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
$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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$61.66
Typical High
$125.89
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$38.02
Typical High
$61.66
Molina
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$75.86
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$61.66
Typical High
$125.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$57.54
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$48.98
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$53.70
Typical High
$64.57
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$61.66
Typical High
$85.11