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Lateral Thoracic Extension for TLSO (Low Profile)

Minnesota rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $513 · 10th–90th $251$2,3990%20%10th90th$513Professionalmedian $295 · 10th–90th $195$3390%50%10th90th$295$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
$204.17
Median
$204.17
Typical High
$204.17
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$204.17
Typical High
$288.40
BCBS
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$295.12
Typical High
$436.52
BCBS
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$295.12
Typical High
$295.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$1,122.02
Typical High
$3,090.30
Cigna
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$389.05
Typical High
$436.52
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$1,230.27
Typical High
$2,398.83
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$467.74
Medica
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$1,548.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$147.91
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$2.34
Median
$147.91
Typical High
$478.63
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$173.78
Typical High
$416.87