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

South Carolina 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 $234 · 10th–90th $178$4900%20%10th90th$234Professionalmedian $209 · 10th–90th $162$3390%20%10th90th$209$100.0$200.0$500.0$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
$177.83
Median
$177.83
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$194.98
Typical High
$338.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$416.87
BCBS
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$416.87
Typical High
$524.81
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
$354.81
Medcost
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$251.19
Typical High
$588.84
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$141.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$263.03
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$245.47
Typical High
$354.81