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Anterior ASIS Pad for TLSO (Low Profile)

Vermont 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 $31$620%20%10th90th$46Professionalmedian $51 · 10th–90th $47$710%20%40%10th90th$51$50.0$100.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$53.70
BCBS
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$69.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$61.66
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$30.90
Median
$41.69
Typical High
$51.29
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$61.66
Typical High
$190.55