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Lateral Thoracic Extension for TLSO (Low Profile)

Utah rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $148 · 10th–90th $95$3890%20%40%10th90th$148Professionalmedian $204 · 10th–90th $95$1,6980%10%20%10th90th$204$50.0$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
$95.50
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$134.90
Typical High
$1,698.24
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$288.40
Typical High
$371.54
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$389.05
Typical High
$389.05
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$281.84
Typical High
$346.74
Select Health
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Select Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$380.19
Typical High
$398.11
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$398.11
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$165.96
Typical High
$363.08
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$147.91
Typical High
$223.87