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Lateral Thoracic Extension for TLSO (Low Profile)

New Hampshire rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $302 · 10th–90th $166$3630%20%10th90th$302Professionalmedian $191 · 10th–90th $148$2570%20%10th90th$191$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
Facility
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$165.96
Typical High
$199.53
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$323.59
Typical High
$363.08
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$181.97
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$165.96
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$190.55
Typical High
$257.04
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$426.58