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New Hampshire rates for HCPCS L1845

Knee Orthosis 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 (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.46 / $552.46 / $662.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.33 / $450.64 / $595.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.86 / $735.86 / $981.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$981.15 / $981.15 / $1,163.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.09 / $557.09 / $587.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $632.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $461.73 / $721.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.40 / $794.40 / $2,451.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.66 / $489.49 / $581.21
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.04 / $769.25 / $1,157.13