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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.

Facilitymedian $1,202 · 10th–90th $479$4,3650%20%10th90th$1,202Professionalmedian $562 · 10th–90th $468$1,1750%20%40%10th90th$562$1.0$10.0$100.0$1.0K$10.0K

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
$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