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LSO, Flexible, Custom Fabricated

Ohio 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 $174$3160%50%90th$174Professionalmedian $174 · 10th–90th $135$2240%20%10th90th$174$50.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$173.78
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$275.42
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$190.55
Typical High
$331.13
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$616.60