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LSO, Flexible, Custom Fabricated

Michigan 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 $437 · 10th–90th $174$1,1480%20%10th90th$437Professionalmedian $174 · 10th–90th $120$2510%50%10th90th$174$100.0$200.0$500.0$1.0K$2.0K

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$758.58
Typical High
$1,445.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$251.19
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$263.03
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$165.96
Typical High
$181.97
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$91.20
Typical High
$173.78
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
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