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Lateral Thoracic Extension for TLSO (Low Profile)

Hawaii rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $186 · 10th–90th $145$3720%50%10th90th$186Professionalmedian $479 · 10th–90th $135$5010%50%10th90th$479$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$436.52
Typical High
$588.84
HMSA
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$501.19
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$478.63
Typical High
$660.69
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$165.96
Typical High
$186.21
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$245.47
Typical High
$588.84