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Milwaukee Type Superstructure for TLSO (Low Profile)

South Dakota rates for HCPCS L1230

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

Rates data updated July 2026.

Facilitymedian $692 · 10th–90th $437$1,1750%10%10th90th$692Professionalmedian $575 · 10th–90th $398$1,1750%20%10th90th$575$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$562.34
Typical High
$575.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$724.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$933.25
Typical High
$1,174.90
Medica
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$812.83
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$501.19
Typical High
$4,265.80
Midlands
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$707.95
Typical High
$707.95
Midlands
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
Midlands
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$588.84
Typical High
$1,513.56
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$851.14
Typical High
$1,122.02
United
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$371.54
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$537.03
Typical High
$933.25
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65