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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Montana rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,023 · 10th–90th $741$1,4130%20%40%10th90th$1,023Professionalmedian $794 · 10th–90th $331$1,9950%20%10th90th$794$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
Professional
Modifier
Global
Typical Low
$331.13
Median
$588.84
Typical High
$6,025.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$1,096.48
Typical High
$1,096.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,096.48
Typical High
$1,096.48
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$1,023.29
Typical High
$1,995.26
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,023.29
Typical High
$1,995.26
Providence
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$954.99
Typical High
$1,479.11
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$812.83
Typical High
$1,148.15
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$645.65
Typical High
$676.08
United
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$512.86
Typical High
$794.33