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Ohio rates for HCPCS L1250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.18 / $51.18 / $163.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.26 / $51.18 / $55.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.48 / $104.82 / $271.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.47 / $49.30 / $123.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.47 / $95.29 / $130.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.70 / $95.29 / $204.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $127.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $78.72
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $61.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $61.62 / $61.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.40 / $55.56 / $72.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.59 / $43.99 / $61.18