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Anterior ASIS Pad for TLSO (Low Profile)

Tennessee rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $79 · 10th–90th $40$4470%20%10th90th$79Professionalmedian $50 · 10th–90th $43$910%20%40%10th90th$50$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
$48.98
Median
$53.70
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$48.98
Typical High
$91.20
BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$87.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$70.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$61.66
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$616.60
Typical High
$616.60
United
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$45.71
Typical High
$109.65
United
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$50.12
Typical High
$61.66