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TLSO, Initial Orthosis Only

Virginia rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $1,820 · 10th–90th $871$2,2390%20%40%10th90th$1,820Professionalmedian $1,047 · 10th–90th $724$1,8200%20%10th90th$1,047$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
$724.44
Median
$870.96
Typical High
$870.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$870.96
Typical High
$1,148.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,905.46
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$2,398.83
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$1,230.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$1,174.90
Typical High
$1,174.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,819.70
Typical High
$2,511.89
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,174.90
Typical High
$1,778.28
Medcost
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$1,230.27
Typical High
$2,398.83
Medcost
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,047.13
Typical High
$2,238.72
Sentara
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,479.11
Typical High
$3,890.45
Sentara
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,479.11
Typical High
$3,890.45
United
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$933.25
Typical High
$2,398.83
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$870.96
Typical High
$1,412.54