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Lateral Thoracic Extension for TLSO (Low Profile)

Montana rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $380 · 10th–90th $234$4790%20%10th90th$380Professionalmedian $275 · 10th–90th $95$7410%10%20%10th90th$275$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
$95.50
Median
$154.88
Typical High
$1,698.24
BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$416.87
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$416.87
Typical High
$416.87
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$380.19
Typical High
$741.31
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$380.19
Typical High
$741.31
Providence
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$346.74
Typical High
$416.87
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$295.12
Typical High
$416.87
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$165.96
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$147.91
Typical High
$223.87