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Milwaukee Type Superstructure for TLSO (Low Profile)

Washington rates for HCPCS L1230

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

Rates data updated July 2026.

Facilitymedian $646 · 10th–90th $437$1,4790%20%10th90th$646Professionalmedian $537 · 10th–90th $316$1,2590%10%10th90th$537$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
$436.52
Median
$436.52
Typical High
$1,023.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$436.52
Typical High
$2,884.03
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$630.96
Typical High
$645.65
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$724.44
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$954.99
Typical High
$1,819.70
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$794.33
Typical High
$1,479.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$446.68
Typical High
$537.03
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$630.96
Typical High
$645.65
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$645.65
Typical High
$851.14
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$933.25
Typical High
$1,288.25
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$630.96
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$645.65
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$724.44
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$870.96
Typical High
$1,047.13
United
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$363.08
Typical High
$630.96
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$549.54
Typical High
$977.24