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Lateral Thoracic Extension for TLSO (Low Profile)

Michigan rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $661 · 10th–90th $170$8910%20%40%10th90th$661Professionalmedian $170 · 10th–90th $141$2950%20%10th90th$170$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
Facility
Modifier
Global
Typical Low
$169.82
Median
$660.69
Typical High
$812.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$165.96
Typical High
$177.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$891.25
Typical High
$1,698.24
BCBS
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$295.12
Typical High
$309.03
CareSource
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$190.55
Typical High
$363.08
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$562.34
Typical High
$630.96
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$363.08
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$245.47
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$239.88
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$141.25
Typical High
$223.87