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Elastic Rib Gusset for TLSO (Low Profile)

New Hampshire rates for HCPCS L1280

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

Rates data updated July 2026.

Facilitymedian $132 · 10th–90th $72$1620%20%10th90th$132Professionalmedian $79 · 10th–90th $51$1120%20%10th90th$79$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
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$87.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$72.44
Typical High
$87.10
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$141.25
Typical High
$162.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$60.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$95.50
Cigna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$72.44
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$50.12
Typical High
$61.66
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$74.13
Typical High
$112.20
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$186.21