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Elastic Rib Gusset for TLSO (Low Profile)

Montana rates for HCPCS L1280

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

Rates data updated July 2026.

Facilitymedian $95 · 10th–90th $72$1170%20%10th90th$95Professionalmedian $78 · 10th–90th $32$1860%10%20%10th90th$78$50.0$100.0$200.0$500.0

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
Professional
Modifier
Global
Typical Low
$31.62
Median
$54.95
Typical High
$562.34
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$102.33
Typical High
$102.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$102.33
Typical High
$102.33
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$95.50
Typical High
$186.21
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$95.50
Typical High
$186.21
Providence
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$91.20
Typical High
$131.83
Providence
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$79.43
Typical High
$102.33
United
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$54.95
Typical High
$60.26
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$48.98
Typical High
$74.13