Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $350.00 | $350.00 | $350.00 | |
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Moda Health
| Facility | $350.00 | $350.00 | $479.50 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Providence
| Facility | $350.00 | $350.00 | $500.50 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |