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Milwaukee Type Superstructure for TLSO (Low Profile)

Utah rates for HCPCS L1230

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

Rates data updated July 2026.

Facilitymedian $316 · 10th–90th $204$8510%20%40%10th90th$316Professionalmedian $437 · 10th–90th $204$2,8840%10%10th90th$437$50.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Aetna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$288.40
Typical High
$2,884.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$398.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$616.60
Typical High
$794.33
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$851.14
Typical High
$851.14
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$602.56
Typical High
$758.58
Select Health
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
Select Health
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$831.76
Typical High
$870.96
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$870.96
Typical High
$870.96
United
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$316.23
Typical High
$776.25
United
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$316.23
Typical High
$489.78