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Anterior ASIS Pad for TLSO (Low Profile)

Washington rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $85 · 10th–90th $58$2000%20%10th90th$85Professionalmedian $71 · 10th–90th $45$1620%10%20%10th90th$71$1.0$5.0$20.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$100.00
Typical High
$138.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$57.54
Typical High
$398.11
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$85.11
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$61.66
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$120.23
Typical High
$245.47
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$100.00
Typical High
$190.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$66.07
Typical High
$72.44
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$83.18
Typical High
$85.11
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$85.11
Typical High
$85.11
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$125.89
Typical High
$169.82
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$83.18
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$85.11
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$109.65
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$47.86
Typical High
$79.43
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$74.13
Typical High
$131.83