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LO, Rigid Anterior and Posterior Panels, Off-the-Shelf

Alaska rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $100$4470%50%90th$100Professionalmedian $275 · 10th–90th $162$5250%10%10th90th$275$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Global
Typical Low
$162.18
Median
$208.93
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$501.19
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$141.25
Typical High
$446.68
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$446.68
Typical High
$707.95
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$446.68
Typical High
$467.74
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$446.68
Typical High
$467.74
Providence
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$436.52
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$302.00
Typical High
$354.81
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$234.42
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$363.08
Typical High
$602.56