Flexible lumbar-sacral back brace at Dignity Health

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

ORTHO L0628 88X-115

Folsom, CA

See all hospitals reporting HCPCS L0628 →

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Pricing by billing methodology

Price type

How this price compares nationally

Dignity Health’s median price of $380 is 453% above the median hospital's median price ($69), higher than 95% of the 1,042 hospitals reporting HCPCS L0628. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L0628 at Dignity Health

Negotiated rates from the hospital’s own file: 9 payers, 35 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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#
1	UnitedHealthcare medicaid\|< 21 fee schedule · outpatient	$53	$53	—	—	—	$53 – $53
2	UnitedHealthcare medicaid\|> 21 fee schedule · outpatient	$53	$53	—	—	—	$53 – $53
3	Molina medicaid\|all plans fee schedule · outpatient	$99	$99	—	—	—	$99 – $99
4	Anthem medicaid\|all plans fee schedule · outpatient	$100	$100	—	—	—	$100 – $100
5	Kaiser commercial\|all plans fee schedule · inpatient	$132	$132	—	—	—	$132 – $132
6	Kaiser medicaid\|all plans fee schedule · inpatient	$132	$132	—	—	—	$132 – $132
7	Kaiser medicare\|all plans fee schedule · inpatient	$132	$132	—	—	—	$132 – $132
8	Anthem medicaid\|all plans fee schedule · inpatient	$138	$138	—	—	—	$138 – $138
9	Molina medicaid\|all plans fee schedule · inpatient	$150	$150	—	—	—	$150 – $150
10	Cigna commercial\|localplus fee schedule · inpatient	$230	$230	—	—	—	$230 – $230
11	Kaiser medicaid\|all plans fee schedule · outpatient	$236	$236	—	—	—	$236 – $236
12	Cigna commercial\|all other plans fee schedule · inpatient	$305	$305	—	—	—	$305 – $305
13	Cigna commercial\|localplus fee schedule · outpatient	$316	$316	—	—	—	$316 – $316
14	UnitedHealthcare commercial\|non-options ppo fee schedule · outpatient	$368	$368	—	—	—	$368 – $368
15	UnitedHealthcare commercial\|hmo fee schedule · outpatient	$380	$380	—	—	—	$380 – $380
16	UnitedHealthcare commercial\|all other plans fee schedule · outpatient	$391	$391	—	—	—	$391 – $391
17	Blue Cross Blue Shield commercial\|aco trio fee schedule · inpatient	$403	$403	—	—	—	$403 – $403
18	Cigna commercial\|all other plans fee schedule · outpatient	$426	$426	—	—	—	$426 – $426
19	First Health commercial\|all plans fee schedule · inpatient	$431	$431	—	—	—	$431 – $431
20	First Health commercial\|all plans fee schedule · outpatient	$431	$431	—	—	—	$431 – $431
21	Anthem commercial\|connection epo fee schedule · outpatient	$454	$454	—	—	—	$454 – $454
22	Kaiser commercial\|all plans fee schedule · outpatient	$454	$454	—	—	—	$454 – $454
23	MultiPlan commercial\|all plans fee schedule · inpatient	$472	$472	—	—	—	$472 – $472
24	MultiPlan commercial\|all plans fee schedule · outpatient	$472	$472	—	—	—	$472 – $472
25	Blue Cross Blue Shield commercial\|aco trio calpers fee schedule · inpatient	$489	$489	—	—	—	$489 – $489

Page 1 of 2 · 35 rates

Last updated: Feb 28, 2026

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See Flexible lumbar-sacral back brace pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.