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

Pennsylvania 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 $316 · 10th–90th $145$5500%20%10th90th$316Professionalmedian $195 · 10th–90th $145$3720%20%10th90th$195$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
$144.54
Median
$144.54
Typical High
$549.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$177.83
Typical High
$426.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$302.00
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$363.08
Typical High
$537.03
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$194.98
Typical High
$281.84
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$269.15
Typical High
$338.84
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$549.54
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$177.83
Typical High
$316.23
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$354.81
Typical High
$977.24
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$316.23
Typical High
$354.81
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$489.78
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$245.47
Typical High
$426.58