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TLSO, Initial Orthosis Only

South Dakota rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $1,995 · 10th–90th $1,413$2,8840%10%20%10th90th$1,995Professionalmedian $1,995 · 10th–90th $1,288$3,0900%20%10th90th$1,995$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$1,548.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,479.11
Typical High
$2,041.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$2,290.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$2,511.89
Typical High
$3,090.30
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$2,137.96
Typical High
$3,981.07
Medica
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,348.96
Typical High
$13,803.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,238.72
Typical High
$2,238.72
Midlands
Setting
Facility
Modifier
Global
Typical Low
$2,290.87
Median
$2,290.87
Typical High
$2,290.87
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$1,862.09
Typical High
$3,801.89
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,778.28
Median
$2,137.96
Typical High
$2,818.38
United
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,023.29
Typical High
$1,479.11
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,412.54
Typical High
$2,511.89
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74