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

Ohio 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 $209$4570%20%40%10th90th$288Professionalmedian $234 · 10th–90th $141$4070%20%10th90th$234$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
$141.25
Median
$275.42
Typical High
$398.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$169.82
Typical High
$275.42
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$309.03
Typical High
$416.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$288.40
Typical High
$575.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$288.40
Typical High
$457.09
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
CareSource
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$263.03
Typical High
$371.54
CareSource
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$281.84
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$331.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$331.13
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$398.11
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$302.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$416.87
Typical High
$588.84
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$457.09
Typical High
$954.99
United
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$257.04
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$234.42
Typical High
$346.74