Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, two-piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $724.44 | $831.76 | $2,570.40 | |
Cigna
| Facility | $1,318.26 | $1,318.26 | $1,318.26 | |
Cigna
| Professional | $954.99 | $954.99 | $954.99 | |
United
| Facility | $1.58 | $1,000.00 | $1,318.26 | |
United
| Professional | $912.01 | $1,071.52 | $1,513.56 |