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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

New Hampshire rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,122 · 10th–90th $617$1,3800%20%40%10th90th$1,122Professionalmedian $741 · 10th–90th $513$9550%20%10th90th$741$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
Facility
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$741.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$616.60
Typical High
$741.31
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,202.26
Typical High
$1,380.38
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$812.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$1,778.28
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$602.56
Typical High
$676.08
United
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$676.08
Typical High
$954.99
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$1,584.89