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

Utah 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 $191 · 10th–90th $191$2690%20%40%90th$191Professionalmedian $219 · 10th–90th $105$5890%10%10th90th$219$50.0$100.0$200.0$500.0

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
$190.55
Median
$190.55
Typical High
$190.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$275.42
Typical High
$588.84
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
Molina
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$112.20
Typical High
$407.38
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$204.17
Typical High
$269.15
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$281.84
Select Health
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Select Health
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$208.93
Typical High
$407.38
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$208.93
Typical High
$309.03
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$218.78
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$213.80
Typical High
$346.74