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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Hawaii rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $676 · 10th–90th $513$1,2590%20%40%10th90th$676Professionalmedian $1,622 · 10th–90th $398$1,6980%50%10th90th$1,622$500.0$1.0K$2.0K

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
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$588.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,479.11
Typical High
$1,995.26
HMSA
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$1,698.24
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,621.81
Typical High
$2,238.72
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$645.65
Typical High
$676.08
United
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$870.96
Typical High
$1,949.84