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LSO, Flexible, Custom Fabricated

Iowa 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 $174 · 10th–90th $174$2630%50%90th$174Professionalmedian $174 · 10th–90th $174$1740%50%$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
$173.78
Median
$173.78
Typical High
$173.78
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
$70.79
Median
$263.03
Typical High
$1,122.02
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$181.97
Typical High
$194.98
Medica
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$173.78
Typical High
$309.03
Medica
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$354.81
Typical High
$1,258.93
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$1,288.25
Midlands
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,047.13
Typical High
$1,047.13