Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, one-piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $596.25 | $596.25 | $596.25 | |
Aetna
| Professional | $596.25 | $915.67 | $3,405.94 | |
Cigna
| Facility | $782.41 | $782.41 | $782.41 | |
Cigna
| Professional | $571.16 | $782.41 | $782.41 | |
Molina
| Professional | $972.76 | $1,215.95 | $1,823.92 | |
Providence
| Facility | $347.99 | $347.99 | $913.78 | |
Providence
| Professional | $571.16 | $782.41 | $1,383.36 | |
United
| Professional | $489.43 | $539.03 | $811.97 |