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TLSO, Initial Orthosis Only

Ohio 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 $1,148$3,4670%20%40%10th90th$2,188Professionalmedian $1,148 · 10th–90th $871$2,2390%20%40%10th90th$1,148$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$1,148.15
Median
$1,584.89
Typical High
$2,041.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,148.15
Typical High
$1,445.44
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,344.23
Typical High
$4,677.35
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,288.25
Typical High
$2,884.03
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$1,862.09
Typical High
$1,995.26
CareSource
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,659.59
Typical High
$2,344.23
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$1,778.28
Typical High
$2,630.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,288.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,445.44
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,230.27
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,258.93
Molina
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,659.59
Typical High
$2,398.83
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$2,454.71
Typical High
$4,570.88
United
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$1,778.28
Typical High
$2,187.76
United
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$1,023.29
Typical High
$1,380.38