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Lateral Thoracic Extension for TLSO (Low Profile)

South Dakota rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $316 · 10th–90th $200$5370%10%10th90th$316Professionalmedian $269 · 10th–90th $186$4270%10%20%10th90th$269$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$218.78
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$331.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$426.58
Medica
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$346.74
Typical High
$741.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$234.42
Typical High
$1,949.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$323.59
Typical High
$323.59
Midlands
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Midlands
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$707.95
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$389.05
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$169.82
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$245.47
Typical High
$346.74
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12