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West Virginia rates for HCPCS L1840

Knee orthosis (KO), derotation, medial-lateral, anterior cruciate ligament, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.82 / $601.82 / $601.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.11 / $575.97 / $601.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.19 / $1,524.69 / $2,038.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $815.43 / $1,355.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $732.96 / $1,345.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.05 / $535.05 / $5,640.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,173.99 / $1,173.99 / $1,173.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.14 / $581.15 / $968.59