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Lateral Thoracic Extension for TLSO (Low Profile)

South Carolina rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $186 · 10th–90th $145$3980%20%10th90th$186Professionalmedian $170 · 10th–90th $141$2570%20%10th90th$170$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
$144.54
Median
$144.54
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$158.49
Typical High
$257.04
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$269.15
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$269.15
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$208.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$338.84
Medcost
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$177.83
Medcost
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$234.42
Typical High
$478.63
Medcost
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$95.50
Molina
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$204.17