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TLSO, Initial Orthosis Only

Washington rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $2,291 · 10th–90th $1,585$4,6770%20%10th90th$2,291Professionalmedian $1,950 · 10th–90th $871$3,6310%10%10th90th$1,950$20.0$100.0$500.0$2.0K$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$3,630.78
Typical High
$6,025.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,584.89
Typical High
$10,232.93
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$2,290.87
Typical High
$2,344.23
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,630.27
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$2,630.27
Typical High
$6,760.83
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$2,570.40
Typical High
$4,073.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$1,819.70
Typical High
$1,995.26
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$2,290.87
Typical High
$2,344.23
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,344.23
Typical High
$2,570.40
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$3,467.37
Typical High
$4,677.35
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,290.87
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$2,290.87
Median
$2,290.87
Typical High
$2,344.23
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,630.27
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$2,398.83
Typical High
$2,884.03
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,023.29
Typical High
$1,737.80
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$2,041.74
Typical High
$3,630.78