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LSO, Flexible, Off-the-Shelf

West 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 $40 · 10th–90th $40$850%50%90th$40Professionalmedian $40 · 10th–90th $28$590%20%10th90th$40$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
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$39.81
Typical High
$48.98
CareSource
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$85.11
CareSource
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$89.13
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$44.67
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$50.12
Typical High
$81.28