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Lateral Thoracic Extension for TLSO (Low Profile)

Pennsylvania rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $398 · 10th–90th $120$1,4130%20%10th90th$398Professionalmedian $145 · 10th–90th $120$2570%20%40%10th90th$145$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
$120.23
Median
$120.23
Typical High
$467.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$245.47
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
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
$190.55
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$524.81
Typical High
$758.58
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$208.93
Typical High
$302.00
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$1,348.96
Typical High
$1,348.96
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$204.17
Typical High
$218.78
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$269.15
Typical High
$831.76
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$245.47
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$1,047.13
Typical High
$1,698.24
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$281.84
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$398.11
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$147.91
Typical High
$316.23