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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

Facilitymedian $269 · 10th–90th $263–$4900%50%10th90th$269Professionalmedian $251 · 10th–90th $162–$5130%20%10th90th$251$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $181.97 / $602.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $446.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $269.15 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $1,122.02 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $436.52 / $501.19
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $263.03 / $407.38
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $407.38 / $457.09
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $295.12 / $1,348.96
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $257.04 / $562.34
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $54.95 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $426.58 / $660.69
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $323.59 / $616.60
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $537.03 / $1,348.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $436.52 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $245.47 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $275.42 / $562.34