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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Indiana rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,148 · 10th–90th $562$1,4130%50%10th90th$1,148Professionalmedian $603 · 10th–90th $513$9770%50%10th90th$603$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
$562.34
Median
$562.34
Typical High
$562.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$562.34
Typical High
$870.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$1,148.15
Typical High
$1,445.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$660.69
Typical High
$1,148.15
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,479.11
Typical High
$1,698.24
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,621.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$1,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$691.83
Typical High
$1,148.15
United
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$562.34
Typical High
$794.33