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Elastic Rib Gusset for TLSO (Low Profile)

Pennsylvania 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 $48$5620%20%10th90th$132Professionalmedian $55 · 10th–90th $41$810%20%40%10th90th$55$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$47.86
Median
$47.86
Typical High
$186.21
Aetna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$54.95
Typical High
$79.43
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$95.50
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$72.44
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$138.04
Typical High
$204.17
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$77.62
Typical High
$117.49
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$537.03
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$186.21
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$56.23
Typical High
$81.28
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$416.87
Typical High
$676.08
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$109.65
Typical High
$109.65
United
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$131.83
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$57.54
Typical High
$107.15