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Anterior ASIS Pad for TLSO (Low Profile)

Utah 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?

$57.54

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $57.54 for this service. The price depends on where it is billed: about $57.54 from a physician practice, and about $61.66 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$57.54$40.74 to $58.88
FacilityA hospital or hospital-owned outpatient department$61.66$26.30 to $81.28

How much rates vary

Facilitymedian $62 · 10th to 90th $26 to $81Professionalmedian $58 · 10th to 90th $26 to $79
$50$100facility $62professional $58

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$26.30
Median
$26.30
Typical High
$26.30
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.30
Median
$26.30
Typical High
$31.62
Cigna
Setting
Facility
Modifier
None
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Cigna
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$44.67
Typical High
$61.66
Molina
Setting
Professional
Modifier
None
Typical Low
$58.88
Median
$58.88
Typical High
$77.62
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$77.62
Median
$81.28
Typical High
$123.03
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$57.54
Median
$57.54
Typical High
$61.66
Select Health
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
Select Health
Setting
Professional
Modifier
None
Typical Low
$41.69
Median
$83.18
Typical High
$87.10
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$66.07
Typical High
$104.71
United
Setting
Facility
Modifier
None
Typical Low
$41.69
Median
$41.69
Typical High
$45.71
United
Setting
Professional
Modifier
None
Typical Low
$31.62
Median
$40.74
Typical High
$64.57
4 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$13.18
Median
$13.18
Typical High
$15.85
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$5.25
Median
$5.25
Typical High
$6.31
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$3.89
Median
$3.89
Typical High
$4.79
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$2.63
Median
$2.63
Typical High
$3.16

Where Utah 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.

Utah· 24th of 51

$57.54

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.