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New Hampshire rates for HCPCS L1830

Knee orthosis (KO), immobilizer, canvas longitudinal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $67.61 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $54.95 / $83.18
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $66.07 / $85.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $79.43 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $70.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $112.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $51.29 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $48.98 / $75.86
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $53.70 / $87.10