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LSO, Flexible, Custom Fabricated

Minnesota 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 $141 · 10th–90th $141$7410%50%90th$141Professionalmedian $141 · 10th–90th $112$1740%50%10th90th$141$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
$141.25
Median
$141.25
Typical High
$776.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$141.25
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$263.03
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$190.55
Typical High
$263.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$173.78
Typical High
$177.83
Medica
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
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