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

Texas 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 $269 · 10th–90th $155$1,3800%20%10th90th$269Professionalmedian $195 · 10th–90th $158$2950%20%40%10th90th$195$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$169.82
Typical High
$213.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$186.21
Typical High
$288.40
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$309.03
Typical High
$331.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$239.88
Typical High
$295.12
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$302.00
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$302.00
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,089.30
Median
$2,089.30
Typical High
$2,089.30
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$288.40
Typical High
$616.60
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$186.21
Typical High
$302.00
Providence
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$302.00
Typical High
$616.60
Providence
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$239.88
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$275.42
Typical High
$346.74
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$302.00
Typical High
$416.87