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Anterior ASIS Pad for TLSO (Low Profile)

Illinois rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $98 · 10th–90th $49$4900%20%10th90th$98Professionalmedian $55 · 10th–90th $43$980%20%10th90th$55$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
$48.98
Median
$48.98
Typical High
$97.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$48.98
Typical High
$97.72
BCBS
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$186.21
Typical High
$660.69
BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$74.13
Typical High
$74.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$97.72
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$109.65
Typical High
$138.04
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$72.44
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$77.62
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$47.86
Typical High
$83.18