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LSO, Flexible, Custom Fabricated

Texas 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 $162$3630%50%10th90th$174Professionalmedian $174 · 10th–90th $174$1910%50%90th$174$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
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
$190.55
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$363.08
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Molina
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$181.97
Providence
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$177.83
Typical High
$363.08
Providence
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$1,258.93
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$208.93