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New Hampshire rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.98 / $165.98 / $199.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.32 / $157.22 / $178.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.77 / $294.77 / $349.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.99 / $176.99 / $188.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $190.69 / $190.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $139.19 / $203.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.67 / $238.67 / $736.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.04 / $147.07 / $188.30
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.79 / $242.87 / $309.11