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Lateral Thoracic Extension for TLSO (Low Profile)

Virginia rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $302 · 10th–90th $145$3890%20%40%10th90th$302Professionalmedian $170 · 10th–90th $123$2950%20%10th90th$170$0.2$2.0$20.0$200.0$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
$120.23
Median
$144.54
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$177.83
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$316.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$371.54
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$204.17
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$181.97
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$302.00
Typical High
$416.87
Medcost
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$194.98
Typical High
$295.12
Medcost
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$194.98
Typical High
$398.11
Medcost
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$194.98
Typical High
$380.19
Sentara
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$245.47
Typical High
$870.96
Sentara
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$245.47
Typical High
$870.96
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$154.88
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$147.91
Typical High
$234.42