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LSO, Flexible, Custom Fabricated

Maine 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 $263 · 10th–90th $263$2630%50%100%$263Professionalmedian $174 · 10th–90th $174$2040%50%90th$174$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
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
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
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60