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TLSO, Initial Orthosis Only

Utah rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $871 · 10th–90th $562$2,1380%20%40%10th90th$871Professionalmedian $1,175 · 10th–90th $562$10,2330%10%10th90th$1,175$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
$562.34
Median
$562.34
Typical High
$562.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$912.01
Typical High
$10,232.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,174.90
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$1,548.82
Typical High
$1,995.26
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$2,137.96
Typical High
$2,137.96
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,513.56
Typical High
$2,630.27
Select Health
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$2,137.96
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$2,137.96
Typical High
$2,398.83
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$2,137.96
Typical High
$2,884.03
United
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$1,096.48
Typical High
$1,949.84
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$870.96
Typical High
$1,348.96