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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

Facilitymedian $269 · 10th–90th $135–$7590%10%20%10th90th$269Professionalmedian $214 · 10th–90th $120–$4270%10%10th90th$214$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $213.80 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $398.11
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $302.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $478.63 / $1,000.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $389.05 / $758.58
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $371.54 / $407.38
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $398.11
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $204.17 / $346.74
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $204.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $213.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $141.25 / $346.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $588.84 / $588.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $218.78 / $371.54
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $120.23 / $346.74