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Anterior ASIS Pad for TLSO (Low Profile)

Idaho rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $81 · 10th–90th $46$1230%20%40%10th90th$81Professionalmedian $59 · 10th–90th $37$950%20%10th90th$59$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
Professional
Modifier
Global
Typical Low
$36.31
Median
$51.29
Typical High
$74.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$83.18
Typical High
$141.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$95.50
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$61.66
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$61.66
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$74.13
Typical High
$97.72
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$87.10
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$74.13
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$83.18
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$95.50
Select Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$87.10
Typical High
$131.83
Select Health
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$83.18
Typical High
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$0.06
Median
$45.71
Typical High
$50.12
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$40.74
Typical High
$58.88