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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Pennsylvania rates for HCPCS L1840

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

Rates data updated July 2026.

How much does Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated cost?

$562

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $562 for this service. The price depends on where it is billed: about $562 from a physician practice, and about $1,202 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$562$479 to $708
FacilityA hospital or hospital-owned outpatient department$1,202$479 to $1,862

How much rates vary

Facilitymedian $1,202 · 10th to 90th $479 to $4,365Professionalmedian $562 · 10th to 90th $468 to $1,175
$500$1K$2K$5K$10K$20K$50Kfacility $1,202professional $562

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$1,862.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$562.34
Typical High
$812.83
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,621.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,548.82
Typical High
$2,238.72
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$831.76
Typical High
$1,174.90
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$1,862.09
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$562.34
Typical High
$870.96
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$4,168.69
Typical High
$6,309.57
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,096.48
Typical High
$1,122.02
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$1,412.54
Typical High
$1,412.54
United
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$575.44
Typical High
$1,202.26

Where Pennsylvania sits

The same service costs 3.4 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 45th of 51

$562

HI $1,622DC $479

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.