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Lateral Thoracic Extension for TLSO (Low Profile)

Maryland rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $170 · 10th–90th $110$3020%10%20%10th90th$170Professionalmedian $141 · 10th–90th $120$2570%20%10th90th$141$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$134.90
Typical High
$239.88
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$204.17
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$302.00
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$147.91
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$147.91
Typical High
$239.88
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$257.04