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Lateral Thoracic Extension for TLSO (Low Profile)

Ohio 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 $158$5130%20%10th90th$302Professionalmedian $158 · 10th–90th $138$3090%20%10th90th$158$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
$158.49
Median
$229.09
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$158.49
Typical High
$245.47
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$316.23
Typical High
$645.65
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$389.05
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$269.15
CareSource
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$251.19
Typical High
$354.81
CareSource
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$263.03
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$208.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$213.80
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$199.53
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$257.04
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$338.84
Typical High
$616.60
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$239.88
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$147.91
Typical High
$223.87