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Lateral Thoracic Extension for TLSO (Low Profile)

Wisconsin 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 $224$6170%20%40%10th90th$302Professionalmedian $282 · 10th–90th $148$5010%20%10th90th$282$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
$147.91
Median
$147.91
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$269.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$501.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$338.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$691.83
Typical High
$1,513.56
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$436.52
Typical High
$575.44
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$245.47
Typical High
$371.54
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$416.87
Typical High
$524.81
Medica
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$295.12
Typical High
$1,548.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$169.82
Typical High
$331.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$316.23
Network Health
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Network Health
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$338.84
Typical High
$588.84
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$245.47
Typical High
$371.54
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$389.05
Quartz
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$457.09
Typical High
$891.25
Quartz
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$616.60
Typical High
$1,584.89
Quartz
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$446.68
Typical High
$1,995.26
Security Health
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$269.15
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$169.82
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$147.91
Typical High
$302.00