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TLSO, Initial Orthosis Only

Illinois rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $2,188 · 10th–90th $1,096$13,8040%20%10th90th$2,188Professionalmedian $1,349 · 10th–90th $933$2,1880%20%10th90th$1,349$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$1,096.48
Median
$1,096.48
Typical High
$2,187.76
Aetna
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,096.48
Typical High
$2,187.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$4,168.69
Typical High
$19,498.45
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,659.59
Typical High
$1,659.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,445.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$2,238.72
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$2,344.23
Typical High
$2,884.03
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$2,818.38
Median
$2,818.38
Typical High
$2,818.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,778.28
Typical High
$2,187.76
United
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,071.52
Typical High
$1,819.70