go back

Anterior ASIS Pad for TLSO (Low Profile)

Georgia rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $110 · 10th–90th $46$4070%20%10th90th$110Professionalmedian $58 · 10th–90th $45$1070%20%10th90th$58$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$51.29
Median
$51.29
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$51.29
Typical High
$95.50
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$263.03
Typical High
$407.38
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$91.20
Typical High
$134.90
CareSource
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
CareSource
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$131.83
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$109.65
Typical High
$158.49
United
Setting
Facility
Modifier
Global
Typical Low
$27.54
Median
$39.81
Typical High
$109.65
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$51.29
Typical High
$97.72