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

Michigan 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 $331 · 10th–90th $186$1,0720%10%20%10th90th$331Professionalmedian $257 · 10th–90th $141$4070%20%10th90th$257$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
$186.21
Median
$186.21
Typical High
$186.21
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$194.98
Typical High
$426.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$794.33
Typical High
$1,513.56
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$275.42
CareSource
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
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
$302.00
Typical High
$489.78
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$288.40
Typical High
$316.23
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$199.53
Typical High
$363.08
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$549.54
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$269.15
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$234.42
Typical High
$389.05