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LSO, Flexible, Custom Fabricated

Hawaii 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 $251 · 10th–90th $251$2630%50%100%90th$251Professionalmedian $32 · 10th–90th $32$1740%50%90th$32$50.0$100.0$200.0$500.0

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
$173.78
Median
$173.78
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
HMSA
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$32.36
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60