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

New York 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 $288 · 10th–90th $170$4790%20%10th90th$288Professionalmedian $282 · 10th–90th $166$5010%20%10th90th$282$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$165.96
Median
$218.78
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$208.93
Typical High
$380.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$562.34
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$724.44
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$354.81
Typical High
$354.81
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$436.52
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$323.59
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$457.09
Typical High
$1,071.52
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$295.12
Typical High
$537.03
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$302.00
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$309.03
Typical High
$323.59
Fidelis
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$190.55
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$263.03
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$257.04
Typical High
$645.65
United
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$263.03
Typical High
$467.74
Univera
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$309.03
Typical High
$346.74
Univera
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$309.03
Typical High
$323.59