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New Hampshire rates for HCPCS L1852

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, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.30 / $586.30 / $703.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.08 / $507.18 / $586.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.54 / $660.54 / $783.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.37 / $653.37 / $653.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.29 / $647.80 / $647.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.90 / $472.90 / $647.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.08 / $800.08 / $2,469.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.32 / $489.49 / $781.75
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.14 / $608.45 / $774.40