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Anterior ASIS Pad for TLSO (Low Profile)

Nebraska rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $83 · 10th–90th $41$4370%20%10th90th$83Professionalmedian $43 · 10th–90th $32$680%20%40%10th90th$43$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$42.66
Typical High
$52.48
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$79.43
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$91.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$109.65
Typical High
$169.82
Medica
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$91.20
Typical High
$436.52
Medica
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$40.74
Typical High
$85.11
Midlands
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$218.78
Midlands
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Midlands
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$204.17
Typical High
$218.78
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$66.07
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$40.74
Typical High
$63.10