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Anterior ASIS Pad for TLSO (Low Profile)

Maine rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $46$1200%20%40%10th90th$100Professionalmedian $54 · 10th–90th $42$830%20%10th90th$54$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$48.98
Typical High
$57.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$128.82
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$66.07
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$69.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$61.66
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$100.00
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$51.29
Typical High
$57.54
United
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$41.69
Typical High
$51.29
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$81.28
Typical High
$83.18