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LSO, Flexible, Custom Fabricated

New York 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 $54$2140%50%10th90th$174Professionalmedian $174 · 10th–90th $174$2400%50%90th$174$50.0$200.0$1.0K$5.0K$20.0K

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
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$263.03
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$177.83
Typical High
$177.83
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$186.21
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$177.83
Typical High
$177.83
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$50,118.72
Typical High
$75,857.76
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$128.82
Typical High
$177.83
Univera
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$177.83
Typical High
$213.80
Univera
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$53.70
Typical High
$177.83