go back

Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Michigan rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,413 · 10th–90th $646$4,5710%20%10th90th$1,413Professionalmedian $646 · 10th–90th $537$1,1220%20%10th90th$646$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$645.65
Median
$645.65
Typical High
$645.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$616.60
Typical High
$645.65
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,479.11
Median
$3,388.44
Typical High
$6,456.54
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,122.02
Typical High
$1,202.26
CareSource
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
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
$741.31
Typical High
$1,288.25
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$2,137.96
Typical High
$2,398.83
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$912.01
Typical High
$1,380.38
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$933.25
Typical High
$1,288.25
United
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$933.25
Typical High
$1,412.54
United
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$537.03
Typical High
$812.83