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TLSO, Initial Orthosis Only

California rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $1,023 · 10th–90th $813$4,6770%20%10th90th$1,023Professionalmedian $1,072 · 10th–90th $813$10,2330%20%10th90th$1,072$2.0$10.0$50.0$200.0$1.0K$5.0K

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
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$10,232.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,071.52
Typical High
$10,232.93
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$1,862.09
Typical High
$1,862.09
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$1,023.29
Typical High
$4,677.35
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,174.90
Typical High
$2,630.27
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$3,715.35
Typical High
$5,754.40
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$2,238.72
Typical High
$6,165.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,174.90
Typical High
$1,174.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,174.90
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,479.11
Typical High
$2,884.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$2,137.96
Typical High
$3,715.35
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$11,481.54
Median
$11,481.54
Typical High
$11,481.54
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$14,125.38
Median
$14,125.38
Typical High
$14,125.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$2,041.74
Typical High
$2,884.03
Providence
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$2,290.87
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$4,466.84
Median
$4,466.84
Typical High
$4,466.84
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,621.81
Typical High
$2,137.96
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$870.96
Typical High
$2,398.83
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,071.52
Typical High
$2,454.71