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

Wisconsin 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 $263$4900%50%10th90th$269Professionalmedian $269 · 10th–90th $166$5130%20%10th90th$269$0.5$2.0$10.0$50.0$200.0$1.0K

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
$165.96
Typical High
$165.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$371.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$446.68
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$1,122.02
Typical High
$1,584.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$446.68
Typical High
$501.19
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$263.03
Typical High
$407.38
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$407.38
Typical High
$457.09
Medica
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$295.12
Typical High
$1,348.96
Medica
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$257.04
Typical High
$562.34
Molina
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$54.95
Typical High
$70.79
Network Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$426.58
Typical High
$660.69
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$263.03
Typical High
$407.38
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$263.03
Quartz
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$323.59
Typical High
$616.60
Quartz
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$549.54
Typical High
$1,380.38
Quartz
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$489.78
Typical High
$2,089.30
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$245.47
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$269.15
Typical High
$707.95