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Elastic Rib Gusset for TLSO (Low Profile)

South Dakota 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 $66$1320%20%10th90th$95Professionalmedian $89 · 10th–90th $62$1510%10%10th90th$89$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$66.07
Typical High
$89.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$109.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$151.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$97.72
Typical High
$181.97
Medica
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$69.18
Typical High
$676.08
Midlands
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$107.15
Midlands
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
Midlands
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$173.78
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$97.72
Typical High
$128.82
United
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$56.23
Typical High
$81.28
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$74.13
Typical High
$123.03
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72