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

Washington 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 $219 · 10th–90th $132$7080%20%10th90th$219Professionalmedian $191 · 10th–90th $115$5130%10%10th90th$191$5.0$20.0$100.0$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
$162.18
Median
$162.18
Typical High
$389.05
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$190.55
Typical High
$524.81
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$263.03
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$141.25
Typical High
$346.74
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$426.58
Typical High
$1,000.00
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$363.08
Typical High
$741.31
Molina
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$371.54
Typical High
$407.38
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$398.11
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$204.17
Typical High
$346.74
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$204.17
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$138.04
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$141.25
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$588.84
Typical High
$588.84
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$371.54
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$208.93
Typical High
$346.74