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LSO, Flexible, Custom Fabricated

Indiana 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 October 2026.

How much does LSO, Flexible, Custom Fabricated cost?

$204

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $204 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $263 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$204$174 to $204
FacilityA hospital or hospital-owned outpatient department$263$263 to $282

How much rates vary

Facilitymedian $263 · 10th to 90th $204 to $955Professionalmedian $204 · 10th to 90th $135 to $263
$100$200$500$1K$2Kfacility $263professional $204

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Aetna
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$389.05
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$204.17
Typical High
$269.15
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$20.42
Median
$20.42
Typical High
$30.20
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$151.36
Median
$151.36
Typical High
$218.78
Cigna
Setting
Facility
Modifier
None
Typical Low
$263.03
Median
$263.03
Typical High
$281.84
Cigna
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$190.55
Typical High
$269.15
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$912.01
Median
$2,089.30
Typical High
$2,290.87
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$245.47
Median
$245.47
Typical High
$245.47

Where Indiana sits

The same service costs 32.4 times more in South Dakota than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Indiana· 4th of 51

$204

SD $1,047HI $32.36

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.