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Anterior ASIS Pad for TLSO (Low Profile)

Montana rates for HCPCS L1250

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

Rates data updated October 2026.

How much does Anterior ASIS Pad for TLSO (Low Profile) cost?

$83.18

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $79.43 from a physician practice, and about $85.11 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$79.43$64.57 to $85.11
FacilityA hospital or hospital-owned outpatient department$85.11$83.18 to $4,786

How much rates vary

Facilitymedian $85 · 10th to 90th $63 to $4,898Professionalmedian $79 · 10th to 90th $41 to $91
$50$100$200$500$1K$2K$5Kfacility $85professional $79

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.30
Median
$50.12
Typical High
$102.33
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$85.11
Typical High
$85.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$85.11
Typical High
$85.11
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$63.10
Median
$104.71
Typical High
$4,897.79
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$93.33
Typical High
$5,011.87
Providence
Setting
Facility
Modifier
None
Typical Low
$61.66
Median
$85.11
Typical High
$85.11
Providence
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$79.43
Typical High
$85.11
United
Setting
Professional
Modifier
None
Typical Low
$37.15
Median
$40.74
Typical High
$67.61

Where Montana sits

The same service costs 2.5 times more in Hawaii than in Arizona. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 7th of 51

$83.18

HI $112AZ $44.67

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.