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New Hampshire rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.51 / $969.51 / $1,163.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.26 / $752.31 / $969.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.83 / $1,721.83 / $2,041.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$874.87 / $874.87 / $916.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.58 / $897.58 / $897.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $900.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,394.09 / $1,394.09 / $4,302.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.27 / $957.27 / $957.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.66 / $859.00 / $1,191.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,289.59 / $1,418.56 / $1,805.44