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New Hampshire rates for HCPCS L1831

Knee orthosis (KO), locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.88 / $194.88 / $233.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.44 / $151.22 / $194.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.12 / $346.12 / $410.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.35 / $198.35 / $202.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.94 / $197.94 / $197.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.50 / $144.50 / $211.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.22 / $280.22 / $864.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.11 / $172.67 / $207.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.13 / $248.74 / $316.58