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Lateral Thoracic Extension for TLSO (Low Profile)

Indiana 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 $145$3720%20%40%10th90th$302Professionalmedian $158 · 10th–90th $132$2570%20%10th90th$158$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
$144.54
Median
$144.54
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$151.36
Typical High
$245.47
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$302.00
Typical High
$380.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$177.83
Typical High
$302.00
CareSource
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$380.19
Typical High
$446.68
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
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$194.98
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$147.91
Typical High
$218.78