go back

LSO, Rigid Anterior and Posterior Panels, Custom Fitted

New York rates for HCPCS L0631

Lumbar-sacral orthosis (LSO), sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Rates data updated July 2026.

Facilitymedian $813 · 10th–90th $525$1,8620%10%20%10th90th$813Professionalmedian $676 · 10th–90th $513$1,7780%20%10th90th$676$1.0$10.0$100.0$1.0K$10.0K

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
$407.38
Median
$575.44
Typical High
$1,380.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$616.60
Typical High
$1,513.56
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$2,454.71
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$676.08
Typical High
$2,041.74
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$1,000.00
Typical High
$1,000.00
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,000.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$1,737.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$831.76
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$2,041.74
Typical High
$4,677.35
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,288.25
Typical High
$2,344.23
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$851.14
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$776.25
Typical High
$812.83
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,174.90
Typical High
$1,380.38
United
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$645.65
Typical High
$1,949.84
United
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$794.33
Typical High
$1,995.26
Univera
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$724.44
Typical High
$851.14
Univera
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$776.25
Typical High
$812.83