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

California 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 $398 · 10th–90th $316$1,0000%20%10th90th$398Professionalmedian $275 · 10th–90th $141$5890%20%10th90th$275$0.5$2.0$10.0$50.0$200.0$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
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$588.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$275.42
Typical High
$588.84
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$269.15
Typical High
$275.42
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$398.11
Typical High
$1,000.00
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$281.84
Typical High
$389.05
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$794.33
Typical High
$1,174.90
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$263.03
Typical High
$537.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$302.00
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$302.00
Typical High
$363.08
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$363.08
Typical High
$645.65
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,089.30
Median
$2,089.30
Typical High
$2,089.30
Molina
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Providence
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$398.11
Providence
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$218.78
Typical High
$302.00
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$309.03
Typical High
$512.86
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$218.78
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$234.42
Typical High
$407.38