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TLSO, Initial Orthosis Only

Michigan rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $4,898 · 10th–90th $1,230$6,4570%20%10th90th$4,898Professionalmedian $1,230 · 10th–90th $871$2,1380%20%40%10th90th$1,230$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
$1,230.27
Median
$4,897.79
Typical High
$5,888.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,071.52
Typical High
$1,230.27
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,818.38
Median
$6,456.54
Typical High
$12,302.69
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,137.96
Typical High
$2,238.72
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,258.93
Median
$1,258.93
Typical High
$1,258.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,174.90
Typical High
$2,187.76
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$4,073.80
Typical High
$4,570.88
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,737.80
Typical High
$2,630.27
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,778.28
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$1,778.28
Typical High
$2,398.83
United
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,023.29
Typical High
$1,479.11