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TLSO, Initial Orthosis Only

New Hampshire 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 $1,175$2,6300%20%10th90th$2,138Professionalmedian $1,259 · 10th–90th $871$1,8200%20%10th90th$1,259$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,412.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,174.90
Typical High
$1,412.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$1,584.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$2,290.87
Typical High
$2,630.27
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,174.90
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
$3,388.44
United
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$1,023.29
Typical High
$1,174.90
United
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,230.27
Typical High
$1,819.70
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$3,019.95