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New Hampshire rates for HCPCS L1000

Cervical-thoracic-lumbar-sacral orthosis (CTLSO) (Milwaukee), inclusive of furnishing initial orthotic, including model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,412.54 / $2,398.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $3,162.28 / $3,548.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,513.56
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,174.90 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,445.44 / $2,511.89
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $4,168.69