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Lateral Thoracic Extension for TLSO (Low Profile)

Idaho rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $282 · 10th–90th $158$3980%20%40%10th90th$282Professionalmedian $209 · 10th–90th $120$3310%10%20%10th90th$209$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
Professional
Modifier
Global
Typical Low
$120.23
Median
$177.83
Typical High
$288.40
BCBS
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$281.84
Typical High
$478.63
BCBS
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$331.13
Typical High
$331.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$263.03
Typical High
$371.54
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$288.40
Typical High
$302.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$257.04
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$288.40
Typical High
$288.40
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$331.13
Select Health
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$309.03
Typical High
$457.09
Select Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$288.40
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$0.23
Median
$169.82
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$147.91
Typical High
$208.93