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Elastic Rib Gusset for TLSO (Low Profile)

Wisconsin rates for HCPCS L1280

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

Rates data updated July 2026.

Facilitymedian $107 · 10th–90th $79$2190%50%10th90th$107Professionalmedian $100 · 10th–90th $54$1780%20%10th90th$100$0.1$0.5$2.0$10.0$50.0$200.0

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
$53.70
Median
$53.70
Typical High
$53.70
Aetna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$91.20
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$177.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$100.00
Typical High
$120.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$245.47
Typical High
$549.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$154.88
Typical High
$204.17
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$87.10
Typical High
$131.83
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$147.91
Typical High
$186.21
Medica
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$104.71
Typical High
$512.86
Medica
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$56.23
Typical High
$120.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$70.79
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Network Health
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$120.23
Typical High
$208.93
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$87.10
Typical High
$131.83
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$104.71
Typical High
$128.82
Quartz
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$162.18
Typical High
$288.40
Quartz
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$218.78
Typical High
$524.81
Quartz
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$158.49
Typical High
$691.83
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$56.23
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$52.48
Typical High
$100.00