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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 October 2026.

How much does Elastic Rib Gusset for TLSO (Low Profile) cost?

$97.72

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $97.72 for this service. The price depends on where it is billed: about $97.72 from a physician practice, and about $112 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$97.72$64.57 to $107
FacilityA hospital or hospital-owned outpatient department$112$89.13 to $112

How much rates vary

Facilitymedian $112 · 10th to 90th $66 to $182Professionalmedian $98 · 10th to 90th $44 to $129
$50$100$200$500facility $112professional $98

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Aetna
Setting
Professional
Modifier
None
Typical Low
$58.88
Median
$66.07
Typical High
$74.13
Cigna
Setting
Facility
Modifier
None
Typical Low
$72.44
Median
$72.44
Typical High
$109.65
Cigna
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$123.03
Typical High
$151.36
Medica
Setting
Facility
Modifier
None
Typical Low
$66.07
Median
$112.20
Typical High
$181.97
Medica
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$61.66
Typical High
$676.08
Midlands
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Midlands
Setting
Facility
Modifier
None
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
Midlands
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$89.13
Typical High
$173.78
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$97.72
Typical High
$112.20
United
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$53.70
Typical High
$81.28
Wellmark
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$97.72
Typical High
$97.72

Where South Dakota sits

The same service costs 3.2 times more in Hawaii than in Florida. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 6th of 51

$97.72

HI $166FL $52.48

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.