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LSO, Flexible, Custom Fabricated

California rates for HCPCS L0629

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, custom fabricated

Rates data updated July 2026.

Facilitymedian $191 · 10th–90th $151$4790%10%20%10th90th$191Professionalmedian $174 · 10th–90th $174$2040%50%90th$174$50.0$100.0$200.0$500.0$1.0K

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
$144.54
Median
$173.78
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$194.98
Typical High
$478.63
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$776.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$263.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$630.96
Typical High
$831.76
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Providence
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$288.40
Providence
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$263.03
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81