go back

Anterior ASIS Pad for TLSO (Low Profile)

South Dakota rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $81 · 10th–90th $56$1120%10%20%10th90th$81Professionalmedian $74 · 10th–90th $51$1380%10%10th90th$74$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$58.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$58.88
Typical High
$74.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$91.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$138.04
Medica
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$83.18
Typical High
$151.36
Medica
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$58.88
Typical High
$457.09
Midlands
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$89.13
Typical High
$89.13
Midlands
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Midlands
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$144.54
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$81.28
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$47.86
Typical High
$67.61
United
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$61.66
Typical High
$112.20
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28