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Lateral Thoracic Extension for TLSO (Low Profile)

Iowa rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $288 · 10th–90th $145$8320%10%10th90th$288Professionalmedian $186 · 10th–90th $120$3630%10%20%10th90th$186$0.2$1.0$5.0$20.0$100.0$500.0

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
$138.04
Median
$204.17
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$186.21
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$331.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$338.84
Typical High
$426.58
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$346.74
Typical High
$371.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$380.19
Typical High
$1,548.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$186.21
Typical High
$489.78
Midlands
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$346.74
Typical High
$457.09
Midlands
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Midlands
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$489.78
Typical High
$489.78
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$245.47
Typical High
$630.96
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$154.88
Typical High
$295.12
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$295.12
Typical High
$295.12