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Elastic Rib Gusset for TLSO (Low Profile)

Washington rates for HCPCS L1280

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

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $68$2240%10%20%10th90th$100Professionalmedian $83 · 10th–90th $54$1910%10%10th90th$83$1.0$5.0$20.0$100.0$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
$67.61
Median
$67.61
Typical High
$162.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$67.61
Typical High
$562.34
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$97.72
Typical High
$100.00
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$112.20
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$144.54
Typical High
$288.40
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$120.23
Typical High
$223.87
Molina
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$77.62
Typical High
$85.11
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$97.72
Typical High
$100.00
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$100.00
Typical High
$100.00
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$147.91
Typical High
$204.17
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$97.72
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$100.00
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$112.20
United
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$131.83
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$56.23
Typical High
$95.50
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$87.10
Typical High
$154.88