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TLSO, Initial Orthosis Only

Alaska rates for HCPCS L1200

Thoracic-lumbar-sacral orthosis (TLSO), inclusive of furnishing initial orthosis only

Rates data updated July 2026.

Facilitymedian $1,072 · 10th–90th $562$3,0200%20%40%10th90th$1,072Professionalmedian $1,380 · 10th–90th $1,072$4,3650%20%10th90th$1,380$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$2,691.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$3,715.35
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,584.89
Typical High
$3,019.95
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$2,290.87
Median
$3,235.94
Typical High
$7,244.36
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$3,090.30
Typical High
$3,235.94
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$3,090.30
Typical High
$3,235.94
Providence
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$2,511.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$1,174.90
Typical High
$2,238.72
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,096.48
Typical High
$1,148.15
United
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,584.89
Typical High
$7,762.47