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Anterior ASIS Pad for TLSO (Low Profile)

Alaska rates for HCPCS L1250

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior ASIS pad

Rates data updated July 2026.

Facilitymedian $49 · 10th–90th $26$1000%20%40%10th90th$49Professionalmedian $62 · 10th–90th $43$1410%20%10th90th$62$50.0$100.0$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
Professional
Modifier
Global
Typical Low
$42.66
Median
$48.98
Typical High
$87.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$120.23
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$67.61
Typical High
$100.00
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$104.71
Typical High
$263.03
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$100.00
Typical High
$104.71
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$100.00
Typical High
$104.71
Providence
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$93.33
Providence
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$61.66
Typical High
$81.28
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$45.71
Typical High
$51.29
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$61.66
Typical High
$257.04