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New Hampshire rates for HCPCS L1845

Knee orthosis (KO), double 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
$549.54 / $549.54 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $549.54 / $831.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,071.52 / $1,230.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $630.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $457.09 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $489.78 / $851.14
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,230.27