HCPCS L1200

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

Current code24 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

Prices for HCPCS L1200 by hospital
HospitalMedicaid managed care rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27—$1,224$3,060
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$1,224$3,060
Harborview Medical CenterSeattleFile dated 2026-04-01—$2,941$4,201
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01———
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$1,224$3,060
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$1,224$3,060
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$1,224$3,060
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$1,224$3,060
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$1,224$3,060
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01———
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01———
Providence Centralia HospitalCentraliaFile dated 2026-04-01———
Providence Regional Medical Center EverettEverettFile dated 2026-04-01———
Providence St Peter HospitalOlympiaFile dated 2026-04-01———
Seattle Children's HospitalSeattle$2,365 – $2,99112 plans$9,200$9,200
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01———
Swedish IssaquahIssaquahFile dated 2026-04-01———
Swedish Medical CenterSeattleFile dated 2026-04-01———
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01———
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$1,224$3,060
University of Washington Medical CtrSeattleFile dated 2026-04-01———
Virginia Mason Medical CenterSeattle———
Wellfound Behavioral Health HospitalTacomaFile dated 2026-08-27———
Yakima Valley MemorialYakimaFile dated 2026-08-27—$1,224$3,060

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Equipment fee, Washington
$2,401 (fee)