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TLSO, Initial Orthosis Only

Hawaii rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $1,148 · 10th–90th $871$2,6920%50%10th90th$1,148Professionalmedian $3,467 · 10th–90th $603$3,6310%50%10th90th$3,467$1.0K$2.0K$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$1,096.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$2,691.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$3,162.28
Typical High
$4,265.80
HMSA
Setting
Professional
Modifier
Global
Typical Low
$3,467.37
Median
$3,467.37
Typical High
$3,630.78
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$3,467.37
Typical High
$4,786.30
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
$1,023.29
Median
$1,479.11
Typical High
$4,168.69