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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 July 2026.

Facilitymedian $2,188 · 10th–90th $1,122$2,6300%20%10th90th$2,188Professionalmedian $1,175 · 10th–90th $912$1,8200%20%10th90th$1,175$1.0K$2.0K$5.0K$10.0K

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
$912.01
Median
$1,071.52
Typical High
$1,258.93
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,089.30
Median
$2,454.71
Typical High
$2,818.38
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,479.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,548.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,174.90
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$2,187.76
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,174.90
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,096.48
Typical High
$1,479.11
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,819.70
Typical High
$1,819.70