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Anterior ASIS Pad for TLSO (Low Profile)

Indiana 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 $47$1100%50%10th90th$98Professionalmedian $49 · 10th–90th $42$760%50%10th90th$49$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
$46.77
Median
$46.77
Typical High
$46.77
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$46.77
Typical High
$67.61
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$97.72
Typical High
$120.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$51.29
Typical High
$97.72
CareSource
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$141.25
Typical High
$162.18
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
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$51.29
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$46.77
Typical High
$67.61