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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
$1,179.81 / $1,179.81 / $1,415.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.45 / $915.51 / $1,271.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,095.32 / $2,095.32 / $2,483.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.50 / $1,138.79 / $1,138.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $1,184.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $864.47 / $1,388.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.50 / $1,696.50 / $5,236.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.89 / $1,045.33 / $1,761.22
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,569.34 / $1,726.27 / $2,197.08