go back

TLSO, Initial Orthosis Only

Pennsylvania rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $2,818 · 10th–90th $724$8,7100%10%10th90th$2,818Professionalmedian $871 · 10th–90th $724$1,5850%20%10th90th$871$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
$724.44
Median
$724.44
Typical High
$2,818.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$851.14
Typical High
$1,584.89
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,445.44
Typical High
$1,819.70
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
$1,174.90
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,659.59
Median
$2,344.23
Typical High
$3,388.44
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,819.70
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,258.93
Typical High
$1,819.70
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$8,128.31
Median
$8,128.31
Typical High
$8,128.31
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,230.27
Typical High
$1,412.54
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$2,137.96
Typical High
$4,897.79
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$851.14
Typical High
$1,584.89
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$1,621.81
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$2,754.23
Median
$6,456.54
Typical High
$10,232.93
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$1,698.24
Typical High
$2,041.74
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$2,398.83
Typical High
$2,398.83
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$891.25
Typical High
$1,819.70