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TLSO, Initial Orthosis Only

Maine rates for HCPCS L1200

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

Rates data updated October 2026.

How much does TLSO, Initial Orthosis Only cost?

$1,175

Typical negotiated rate. In Maine, October 2026.

Insurers have agreed to pay about $1,175 for this service. The price depends on where it is billed: about $1,175 from a physician practice, and about $2,570 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1,175$1,000 to $1,259
FacilityA hospital or hospital-owned outpatient department$2,570$2,089 to $4,571

How much rates vary

Facilitymedian $2,570 · 10th to 90th $1,479 to $5,012Professionalmedian $1,175 · 10th to 90th $871 to $1,820
$1K$2K$5Kfacility $2,570professional $1,175

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$933.25
Median
$1,258.93
Typical High
$1,258.93
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$2,089.30
Median
$2,630.27
Typical High
$5,011.87
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$1,148.15
Median
$1,174.90
Typical High
$1,258.93
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$114.82
Median
$114.82
Typical High
$125.89
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$851.14
Median
$851.14
Typical High
$933.25
Cigna
Setting
Facility
Modifier
None
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,548.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$870.96
Median
$870.96
Typical High
$1,174.90
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$812.83
Median
$1,819.70
Typical High
$2,398.83
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$1,071.52
Median
$1,258.93
Typical High
$1,258.93
United
Setting
Facility
Modifier
None
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,479.11
United
Setting
Professional
Modifier
None
Typical Low
$812.83
Median
$1,047.13
Typical High
$2,884.03
8 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$562.34
Median
$630.96
Typical High
$630.96
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$223.87
Median
$257.04
Typical High
$257.04
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$165.96
Median
$190.55
Typical High
$190.55
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$112.20
Median
$125.89
Typical High
$125.89
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$562.34
Median
$630.96
Typical High
$630.96
Martin's Point
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$223.87
Median
$257.04
Typical High
$257.04
Martin's Point
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$165.96
Median
$190.55
Typical High
$190.55
Martin's Point
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$112.20
Median
$125.89
Typical High
$125.89

Where Maine sits

The same service costs 4.0 times more in Hawaii than in Pennsylvania. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Maine· 26th of 51

$1,175

HI $3,467PA $871

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.