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LSO, Flexible, Custom Fabricated

Massachusetts 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 $89$3,6310%50%10th90th$174Professionalmedian $174 · 10th–90th $174$1740%50%$174$100.0$500.0$2.0K$10.0K$50.0K

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
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$162.18
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
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
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Health New England
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$162.18
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19