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Anterior ASIS Pad for TLSO (Low Profile)

Kentucky rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $56 · 10th–90th $36$1510%20%10th90th$56Professionalmedian $49 · 10th–90th $45$680%20%40%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
$56.23
Median
$56.23
Typical High
$57.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$51.29
Typical High
$64.57
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$109.65
Typical High
$117.49
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$47.86
Typical High
$51.29
CareSource
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$147.91
Typical High
$190.55
CareSource
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$134.90
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$151.36
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$75.86
Typical High
$457.09
Molina
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$72.44
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$27.54
Median
$39.81
Typical High
$51.29
United
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$48.98
Typical High
$67.61