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Elastic Rib Gusset for TLSO (Low Profile)

North Carolina rates for HCPCS L1280

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

Rates data updated July 2026.

Facilitymedian $87 · 10th–90th $45$2040%20%10th90th$87Professionalmedian $76 · 10th–90th $47$870%20%40%10th90th$76$0.1$1.0$10.0$100.0$1.0K

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
$87.10
Median
$87.10
Typical High
$87.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$87.10
Typical High
$87.10
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$147.91
Typical High
$199.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$83.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$72.44
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$77.62
Medcost
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$48.98
Typical High
$77.62
Medcost
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$87.10
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$74.13
Typical High
$102.33
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$48.98
Typical High
$72.44
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$524.81
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$776.25