go back

TLSO, Initial Orthosis Only

Wisconsin rates for HCPCS L1200

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

Rates data updated July 2026.

Facilitymedian $2,188 · 10th–90th $1,622$4,4670%50%10th90th$2,188Professionalmedian $2,042 · 10th–90th $1,072$3,6310%20%10th90th$2,042$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
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,778.28
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$3,630.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$2,041.74
Typical High
$2,398.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$5,011.87
Typical High
$11,220.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$3,162.28
Typical High
$4,168.69
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,778.28
Typical High
$2,691.53
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$2,630.27
Typical High
$3,235.94
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$2,137.96
Typical High
$9,772.37
Medica
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,071.52
Typical High
$2,344.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$1,047.13
Network Health
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$3,467.37
Typical High
$3,467.37
Network Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,454.71
Typical High
$4,265.80
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,778.28
Typical High
$2,691.53
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$2,137.96
Typical High
$2,344.23
Quartz
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$3,311.31
Typical High
$5,248.07
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$4,466.84
Typical High
$10,000.00
Quartz
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$3,311.31
Typical High
$14,125.38
Security Health
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,995.26
Typical High
$2,041.74
United
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$1,047.13
Typical High
$2,187.76
United
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,071.52
Typical High
$1,905.46