go back

Lateral Thoracic Extension for TLSO (Low Profile)

North Carolina rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $257 · 10th–90th $135$5890%20%10th90th$257Professionalmedian $224 · 10th–90th $135$2750%20%40%10th90th$224$0.2$2.0$20.0$200.0$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
$257.04
Median
$257.04
Typical High
$257.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$257.04
Typical High
$275.42
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$269.15
BCBS
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$295.12
Typical High
$588.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$213.80
Medcost
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$147.91
Typical High
$194.98
Medcost
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$257.04
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$223.87
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$223.87
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$1,584.89
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$2,951.21