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Elastic Rib Gusset for TLSO (Low Profile)

Hawaii rates for HCPCS L1280

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), rib gusset (elastic), each

Rates data updated July 2026.

Facilitymedian $62 · 10th–90th $48$1290%20%10th90th$62Professionalmedian $166 · 10th–90th $35$1740%50%10th90th$166$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$35.48
Typical High
$53.70
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$128.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$154.88
Typical High
$204.17
HMSA
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$173.78
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$54.95
Typical High
$61.66
United
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$81.28
Typical High
$204.17