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LSO, Flexible, Off-the-Shelf

Vermont 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 $56 · 10th–90th $34$580%50%10th90th$56Professionalmedian $48 · 10th–90th $45$690%50%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
$44.67
Median
$47.86
Typical High
$54.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
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
$74.13
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$77.62
Typical High
$77.62
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$44.67
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$69.18
Typical High
$147.91