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Lateral Thoracic Extension for TLSO (Low Profile)

Arizona rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $339 · 10th–90th $105$8130%10%10th90th$339Professionalmedian $158 · 10th–90th $123$3980%20%10th90th$158$0.2$1.0$5.0$20.0$100.0$500.0$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
Professional
Modifier
Global
Typical Low
$123.03
Median
$165.96
Typical High
$218.78
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$446.68
Typical High
$851.14
BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$398.11
Typical High
$831.76
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
$190.55
Medica
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$275.42
Typical High
$1,548.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$147.91
Typical High
$1,949.84
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$323.59
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$223.87