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New Hampshire rates for HCPCS L1250

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

Facilitymedian $98 · 10th–90th $54–$1150%10%20%10th90th$98Professionalmedian $65 · 10th–90th $41–$890%20%10th90th$65$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $52.48 / $74.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $102.33 / $117.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $51.29
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $61.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $154.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.12 / $41.69 / $47.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $56.23 / $83.18
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $134.90