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Anterior ASIS Pad for TLSO (Low Profile)

Ohio 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 $51$1550%20%10th90th$98Professionalmedian $51 · 10th–90th $45$1000%20%10th90th$51$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
$51.29
Median
$63.10
Typical High
$91.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$51.29
Typical High
$57.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$102.33
Typical High
$208.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$56.23
Typical High
$125.89
CareSource
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$91.20
Typical High
$128.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$97.72
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$67.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$67.61
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$64.57
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$61.66
Molina
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$57.54
Typical High
$83.18
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$109.65
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$77.62
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$45.71
Typical High
$66.07