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Lateral Thoracic Extension for TLSO (Low Profile)

Washington rates for HCPCS L1210

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

Rates data updated July 2026.

Facilitymedian $295 · 10th–90th $204$6760%20%10th90th$295Professionalmedian $245 · 10th–90th $148$5750%10%20%10th90th$245$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
$199.53
Median
$371.54
Typical High
$524.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$199.53
Typical High
$1,698.24
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$288.40
Typical High
$295.12
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$331.13
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$436.52
Typical High
$851.14
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$363.08
Typical High
$676.08
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$223.87
Typical High
$251.19
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$288.40
Typical High
$309.03
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$295.12
Typical High
$309.03
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$436.52
Typical High
$588.84
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$288.40
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$295.12
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$331.13
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$398.11
Typical High
$478.63
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$169.82
Typical High
$281.84
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$257.04
Typical High
$446.68