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New Hampshire rates for HCPCS L1200

Thoracic-lumbar-sacral orthosis (TLSO), inclusive of furnishing initial orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,096.48 / $2,041.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,290.87 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,174.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,174.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $912.01 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,047.13 / $1,819.70
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $3,019.95