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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Rhode Island rates for HCPCS L1840

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

Rates data updated October 2026.

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

$646

Typical negotiated rate. In Rhode Island, October 2026.

Insurers have agreed to pay about $646 for this service. The price depends on where it is billed: about $646 from a physician practice, and about $2,042 from a hospital or other facility.

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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$646$550 to $724
FacilityA hospital or hospital-owned outpatient department$2,042$1,585 to $2,344

How much rates vary

Facilitymedian $2,042 · 10th to 90th $1,413 to $2,570Professionalmedian $646 · 10th to 90th $501 to $912
$500$1K$2Kfacility $2,042professional $646

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$323.59
Median
$323.59
Typical High
$323.59
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$1,584.89
Median
$2,187.76
Typical High
$2,570.40
BCBS Rhode Island
Setting
Professional
Modifier
None
Typical Low
$501.19
Median
$724.44
Typical High
$1,000.00
Cigna
Setting
Facility
Modifier
None
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Cigna
Setting
Professional
Modifier
None
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
United
Setting
Facility
Modifier
None
Typical Low
$1,412.54
Median
$1,412.54
Typical High
$1,412.54
United
Setting
Professional
Modifier
None
Typical Low
$416.87
Median
$602.56
Typical High
$912.01

Where Rhode Island sits

The same service costs 3.0 times more in Hawaii than in Vermont. 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.

Rhode Island· 36th of 51

$646

HI $1,622VT $537

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.