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Lateral Thoracic Extension for TLSO (Low Profile)

Georgia rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $302 · 10th–90th $141$1,2020%10%20%10th90th$302Professionalmedian $178 · 10th–90th $138$2880%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
$141.25
Median
$363.08
Typical High
$1,258.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$151.36
Typical High
$269.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$269.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$707.95
Typical High
$1,096.48
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$245.47
Typical High
$398.11
CareSource
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
CareSource
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$407.38
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$302.00
Typical High
$549.54
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$144.54
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$147.91
Typical High
$288.40