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Milwaukee Type Superstructure for TLSO (Low Profile)

Pennsylvania rates for HCPCS L1230

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), Milwaukee type superstructure

Rates data updated July 2026.

Facilitymedian $871 · 10th–90th $295$3,4670%20%10th90th$871Professionalmedian $347 · 10th–90th $295$6920%20%10th90th$347$1.0$10.0$100.0$1.0K$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
$295.12
Median
$295.12
Typical High
$1,148.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$338.84
Typical High
$537.03
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$1,000.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$398.11
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,148.15
Typical High
$1,659.59
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$512.86
Typical High
$741.31
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$1,148.15
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$346.74
Typical High
$562.34
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$2,570.40
Typical High
$4,168.69
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$691.83
Typical High
$812.83
United
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$870.96
Typical High
$870.96
United
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$363.08
Typical High
$776.25