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Lateral Thoracic Extension for TLSO (Low Profile)

California rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $170 · 10th–90th $135$7760%20%10th90th$170Professionalmedian $178 · 10th–90th $135$1,6980%20%10th90th$178$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
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$1,698.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$1,698.24
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$169.82
Typical High
$776.25
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$181.97
Typical High
$436.52
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$616.60
Typical High
$954.99
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$371.54
Typical High
$1,023.29
Cigna
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$190.55
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$165.96
Typical High
$478.63
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$363.08
Typical High
$630.96
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$1,905.46
Typical High
$1,905.46
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$2,951.21
Typical High
$2,951.21
Molina
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$436.52
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$316.23
Typical High
$478.63
Providence
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$288.40
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$144.54
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$177.83
Typical High
$407.38