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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Alaska rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $631 · 10th–90th $331$1,4130%20%40%10th90th$631Professionalmedian $741 · 10th–90th $550$2,0420%20%10th90th$741$100.0$200.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$616.60
Typical High
$1,258.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$1,737.80
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$812.83
Typical High
$1,412.54
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,513.56
Typical High
$3,630.78
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,445.44
Typical High
$1,513.56
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,445.44
Typical High
$1,513.56
Providence
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$1,412.54
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$741.31
Typical High
$1,148.15
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$645.65
Typical High
$676.08
United
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$794.33
Typical High
$3,715.35