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Lateral Thoracic Extension for TLSO (Low Profile)

New York rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $245 · 10th–90th $141$7760%20%10th90th$245Professionalmedian $182 · 10th–90th $135$5620%20%10th90th$182$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$134.90
Median
$245.47
Typical High
$776.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$158.49
Typical High
$245.47
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$794.33
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$616.60
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$331.13
Typical High
$331.13
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$213.80
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$660.69
Typical High
$1,548.82
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$416.87
Typical High
$758.58
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$251.19
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$239.88
Typical High
$251.19
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$380.19
Typical High
$457.09
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$524.81
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$257.04
Typical High
$660.69
Univera
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$239.88
Typical High
$251.19
Univera
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$239.88
Typical High
$251.19