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Elastic Rib Gusset for TLSO (Low Profile)

Utah rates for HCPCS L1280

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

Rates data updated July 2026.

Facilitymedian $48 · 10th–90th $32$980%20%40%10th90th$48Professionalmedian $59 · 10th–90th $32$5620%10%10th90th$59$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
$31.62
Median
$31.62
Typical High
$31.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$44.67
Typical High
$562.34
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$72.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$70.79
Typical High
$91.20
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$97.72
Typical High
$97.72
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$69.18
Typical High
$112.20
Select Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Select Health
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$100.00
Typical High
$102.33
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$100.00
Typical High
$123.03
United
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$48.98
Typical High
$89.13
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$48.98
Typical High
$74.13