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Lateral Thoracic Extension for TLSO (Low Profile)

Missouri rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $240 · 10th–90th $155$5130%20%10th90th$240Professionalmedian $178 · 10th–90th $138$3550%20%40%10th90th$178$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
$154.88
Median
$154.88
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$158.49
Typical High
$1,698.24
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$223.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$1,047.13
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$177.83
Typical High
$275.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$288.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Medica
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$234.42
Typical High
$1,548.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$1,949.84
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$295.12