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LSO, Flexible, Off-the-Shelf

Utah 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 $37 · 10th–90th $29$550%20%40%10th90th$37Professionalmedian $42 · 10th–90th $16$1200%10%10th90th$42$10.0$20.0$50.0$100.0

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
$28.84
Median
$28.84
Typical High
$28.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$33.88
Typical High
$120.23
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
$57.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$22.91
Typical High
$83.18
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$41.69
Typical High
$54.95
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$57.54
Select Health
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$42.66
Select Health
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$42.66
Typical High
$83.18
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$42.66
Typical High
$63.10
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$44.67
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$43.65
Typical High
$64.57