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New Hampshire rates for HCPCS L1844

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, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $2,089.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,089.30 / $2,398.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,174.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,951.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $933.25 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,698.24
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,754.23