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Lateral Thoracic Extension for TLSO (Low Profile)

Alaska rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Rates data updated July 2026.

Facilitymedian $191 · 10th–90th $95$4270%20%40%10th90th$191Professionalmedian $219 · 10th–90th $145$6030%10%10th90th$219$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Global
Typical Low
$144.54
Median
$177.83
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$512.86
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$288.40
Typical High
$426.58
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$446.68
Typical High
$912.01
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$426.58
Typical High
$446.68
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$426.58
Typical High
$446.68
Providence
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$398.11
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$190.55
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$165.96
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$223.87
Typical High
$1,096.48