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TLSO, Initial Orthosis Only

New York rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $1,230 · 10th–90th $776$3,4670%20%10th90th$1,230Professionalmedian $1,175 · 10th–90th $776$2,6920%20%40%10th90th$1,175$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
$602.56
Median
$1,122.02
Typical High
$3,467.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$977.24
Typical High
$1,584.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$3,630.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$3,090.30
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$1,479.11
Typical High
$1,479.11
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$1,479.11
Typical High
$1,479.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$2,884.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,412.54
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$2,951.21
Typical High
$6,918.31
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,905.46
Typical High
$3,388.44
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,288.25
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,122.02
Typical High
$1,230.27
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,737.80
Typical High
$2,041.74
United
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$1,096.48
Typical High
$3,090.30
United
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$1,174.90
Typical High
$2,884.03
Univera
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,096.48
Typical High
$1,288.25
Univera
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,122.02
Typical High
$1,230.27