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New Hampshire rates for HCPCS L1851

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, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.54 / $630.54 / $756.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.18 / $462.40 / $630.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$885.07 / $885.07 / $885.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.40 / $692.40 / $820.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.32 / $685.32 / $685.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.97 / $636.97 / $712.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $464.99 / $679.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.45 / $860.45 / $2,655.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.94 / $526.41 / $714.62
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.88 / $654.37 / $832.83