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Anterior ASIS Pad for TLSO (Low Profile)

Wisconsin rates for HCPCS L1250

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

Rates data updated July 2026.

Facilitymedian $98 · 10th–90th $72$1950%20%40%10th90th$98Professionalmedian $91 · 10th–90th $48$1620%20%10th90th$91$0.1$0.5$2.0$10.0$50.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$97.72
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$162.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$223.87
Typical High
$501.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$141.25
Typical High
$181.97
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$77.62
Typical High
$120.23
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$114.82
Typical High
$144.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$95.50
Typical High
$436.52
Medica
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$47.86
Typical High
$104.71
Molina
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$58.88
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Network Health
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$109.65
Typical High
$190.55
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$77.62
Typical High
$120.23
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$93.33
Typical High
$95.50
Quartz
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$144.54
Typical High
$245.47
Quartz
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$199.53
Typical High
$446.68
Quartz
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$144.54
Typical High
$467.74
United
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$45.71
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$47.86
Typical High
$87.10