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Lateral Thoracic Extension for TLSO (Low Profile)

Texas rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $229 · 10th–90th $132$7940%10%10th90th$229Professionalmedian $141 · 10th–90th $129$2190%50%10th90th$141$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$131.83
Median
$158.49
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$141.25
Typical High
$218.78
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$141.25
Baylor Scott & White
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$302.00
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$239.88
Typical High
$302.00
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$302.00
Typical High
$302.00
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
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$1,905.46
Typical High
$1,905.46
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$2,951.21
Typical High
$2,951.21
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$229.09
Typical High
$407.38
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$257.04
Typical High
$302.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$190.55
Providence
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$223.87
Typical High
$407.38
Providence
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$239.88
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$177.83
Typical High
$208.93
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$302.00
Typical High
$407.38