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LSO, Flexible, Off-the-Shelf

Virginia 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 $65 · 10th–90th $46$1170%50%10th90th$65Professionalmedian $49 · 10th–90th $30$870%20%10th90th$49$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$27.54
Median
$48.98
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$48.98
Typical High
$53.70
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$69.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$112.20
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$54.95
Typical High
$54.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$38.02
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
$42.66
Median
$67.61
Typical High
$107.15
Medcost
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$66.07
Typical High
$100.00
Medcost
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$58.88
Typical High
$102.33
Medcost
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$61.66
Typical High
$81.28
Sentara
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$74.13
Typical High
$288.40
Sentara
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$74.13
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$48.98
Typical High
$77.62