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New Hampshire rates for HCPCS L1843

Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.13 / $594.13 / $712.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.25 / $461.03 / $640.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.16 / $1,055.16 / $1,250.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.00 / $445.00 / $616.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.03 / $702.03 / $702.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.48 / $512.48 / $748.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.33 / $854.33 / $2,636.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.94 / $526.41 / $810.78
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.40 / $758.34 / $965.16