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New Hampshire rates for HCPCS L1840

Knee orthosis (KO), derotation, medial-lateral, anterior cruciate ligament, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.76 / $618.76 / $742.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.41 / $507.34 / $618.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,098.93 / $1,098.93 / $1,302.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.91 / $656.91 / $661.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $732.96 / $732.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.05 / $535.05 / $732.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.74 / $889.74 / $2,746.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.49 / $548.24 / $661.70
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.05 / $905.36 / $1,152.27