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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

West Virginia rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $603 · 10th–90th $603$1,5140%50%90th$603Professionalmedian $575 · 10th–90th $479$7410%50%10th90th$575$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$602.56
Aetna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$575.44
Typical High
$602.56
CareSource
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,513.56
CareSource
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$1,348.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$1,621.81
Typical High
$1,621.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$5,754.40
United
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$645.65
Typical High
$1,202.26
United
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$660.69
Typical High
$977.24