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

South Dakota 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 $372 · 10th–90th $275$6170%10%20%10th90th$372Professionalmedian $302 · 10th–90th $224$4370%10%20%10th90th$302$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$257.04
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$436.52
Medica
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$416.87
Typical High
$758.58
Medica
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$331.13
Typical High
$2,041.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Midlands
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$457.09
Midlands
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$891.25
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$346.74
Typical High
$416.87
United
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$257.04
Typical High
$371.54
United
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$316.23
Typical High
$398.11
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38