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New Hampshire rates for HCPCS L1250

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior ASIS pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.51 / $53.51 / $64.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.01 / $41.53 / $53.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.04 / $95.04 / $112.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.30 / $49.30 / $51.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $61.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $44.98 / $65.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.95 / $76.95 / $237.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.61 / $47.41 / $75.73
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.19 / $78.31 / $99.67