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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Iowa rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $891 · 10th–90th $562$2,8840%20%10th90th$891Professionalmedian $708 · 10th–90th $479$1,5140%20%10th90th$708$1.0$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$758.58
Typical High
$794.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$660.69
Typical High
$1,071.52
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,202.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,318.26
Typical High
$1,659.59
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,288.25
Typical High
$1,380.38
Medica
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$1,348.96
Typical High
$5,495.41
Medica
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$676.08
Typical High
$1,778.28
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,230.27
Typical High
$1,621.81
Midlands
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,778.28
Typical High
$1,778.28
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,513.56
Typical High
$2,290.87
United
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$870.96
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$562.34
Typical High
$1,122.02
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,071.52
Typical High
$1,071.52