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

Montana 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 $240 · 10th–90th $200$5750%20%10th90th$240Professionalmedian $275 · 10th–90th $93$4270%10%10th90th$275$100.0$200.0$500.0

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
$93.33
Median
$275.42
Typical High
$588.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$426.58
Typical High
$426.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$426.58
Typical High
$426.58
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$229.09
Typical High
$575.44
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$229.09
Typical High
$575.44
Providence
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$309.03
Typical High
$467.74
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$257.04
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$234.42
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$218.78
Typical High
$346.74