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TLSO, Initial Orthosis Only

Idaho rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $2,138 · 10th–90th $955$2,9510%20%40%10th90th$2,138Professionalmedian $1,585 · 10th–90th $724$2,6300%10%20%10th90th$1,585$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
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,412.54
Typical High
$2,041.74
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$2,238.72
Typical High
$3,801.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$2,630.27
Typical High
$2,630.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,479.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,174.90
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,862.09
Typical High
$2,398.83
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$2,290.87
Typical High
$2,398.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$2,041.74
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$2,290.87
Typical High
$2,290.87
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$1,698.24
Typical High
$2,630.27
Select Health
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$2,398.83
Typical High
$3,630.78
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,290.87
Typical High
$2,630.27
United
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1,023.29
Typical High
$1,174.90
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$870.96
Typical High
$1,258.93