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Anterior ASIS Pad for TLSO (Low Profile)

Oklahoma rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $46 · 10th–90th $42$1100%20%40%10th90th$46Professionalmedian $45 · 10th–90th $34$620%20%10th90th$45$20.0$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
$41.69
Median
$43.65
Typical High
$43.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$48.98
Typical High
$57.54
BCBS
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$89.13
Medica
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$58.88
Typical High
$436.52
Medica
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$43.65
Typical High
$112.20
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$74.13
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$40.74
Typical High
$58.88