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LSO, Flexible, Off-the-Shelf

Wyoming 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 $45 · 10th–90th $41$500%20%40%10th90th$45Professionalmedian $41 · 10th–90th $19$520%20%10th90th$41$20.0$50.0

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
$19.05
Median
$23.44
Typical High
$52.48
BCBS
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$40.74
Typical High
$40.74
BCBS
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$40.74
Typical High
$40.74
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
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$44.67
Typical High
$50.12
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$44.67
Typical High
$69.18