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New Hampshire rates for HCPCS L2795

Addition to lower extremity orthosis, knee control, full kneecap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.87 / $71.87 / $86.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.02 / $55.76 / $71.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.64 / $127.64 / $151.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.96 / $57.96 / $61.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.69 / $62.81 / $62.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $45.85 / $66.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.34 / $103.34 / $318.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.45 / $63.68 / $75.59
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.60 / $112.24 / $168.64