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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

New Jersey rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $398 · 10th–90th $398$1,2020%20%40%90th$398Professionalmedian $575 · 10th–90th $457$1,1750%10%20%10th90th$575$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
$398.11
Median
$398.11
Typical High
$398.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$537.03
Typical High
$676.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$741.31
Typical High
$1,202.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,122.02
Typical High
$1,548.82
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
United
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$691.83
Typical High
$1,202.26
United
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$630.96
Typical High
$1,174.90