Thoracic-lumbar-sacral orthosis (TLSO), sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $773.66 | $773.66 | $773.66 | |
Cigna
| Facility | $576.88 | $576.88 | $576.88 | |
Cigna
| Professional | $421.12 | $576.88 | $614.98 | |
Moda Health
| Facility | $266.24 | $266.24 | $266.24 | |
Moda Health
| Professional | $857.98 | $857.98 | $1,354.71 | |
Providence
| Facility | $266.24 | $266.24 | $576.88 | |
Providence
| Professional | $421.12 | $614.98 | $1,058.35 | |
United
| Professional | $436.51 | $863.59 | $1,126.43 |