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Anterior ASIS Pad for TLSO (Low Profile)

Texas rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $69 · 10th–90th $41$1860%10%20%10th90th$69Professionalmedian $45 · 10th–90th $39$680%50%10th90th$45$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$40.74
Median
$42.66
Typical High
$52.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$44.67
Typical High
$57.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
BCBS
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$43.65
Typical High
$54.95
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$70.79
Typical High
$93.33
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$93.33
Typical High
$93.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$151.36
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$72.44
Typical High
$120.23
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$83.18
Typical High
$93.33
Molina
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$60.26
Providence
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$70.79
Typical High
$120.23
Providence
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$61.66
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$74.13
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$48.98
Typical High
$58.88
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$93.33
Typical High
$125.89