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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Ohio rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,148 · 10th–90th $603$1,9050%20%40%10th90th$1,148Professionalmedian $603 · 10th–90th $537$1,1750%20%40%10th90th$603$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
$602.56
Median
$831.76
Typical High
$1,071.52
Aetna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$602.56
Typical High
$741.31
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,230.27
Typical High
$2,454.71
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$676.08
Typical High
$1,513.56
CareSource
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$954.99
Typical High
$1,348.96
CareSource
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,023.29
Typical High
$1,513.56
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
$776.25
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$776.25
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
Molina
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$691.83
Typical High
$1,000.00
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,288.25
Typical High
$2,398.83
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$933.25
Typical High
$1,202.26
United
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$549.54
Typical High
$812.83