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New Hampshire rates for HCPCS L1110

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.19 / $191.19 / $229.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.42 / $148.36 / $191.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.56 / $339.56 / $402.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.24 / $175.24 / $183.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.30 / $225.30 / $225.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.47 / $164.47 / $232.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.93 / $274.93 / $848.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.94 / $169.40 / $201.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.32 / $279.75 / $356.05