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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Missouri rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $871 · 10th–90th $550$1,8620%20%10th90th$871Professionalmedian $631 · 10th–90th $525$1,2880%20%40%10th90th$631$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
$549.54
Median
$549.54
Typical High
$630.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$588.84
Typical High
$6,025.60
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$3,801.89
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$660.69
Typical High
$1,000.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$1,071.52
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,096.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
Medica
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$851.14
Typical High
$5,495.41
Medica
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$524.81
Typical High
$6,606.93
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$870.96
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$524.81
Typical High
$1,000.00