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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

South Dakota rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,023 · 10th–90th $724$1,4130%10%20%10th90th$1,023Professionalmedian $977 · 10th–90th $661$1,6600%10%10th90th$977$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$758.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$707.95
Typical High
$1,047.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,202.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,659.59
Medica
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$1,047.13
Typical High
$1,949.84
Medica
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$741.31
Typical High
$6,606.93
Midlands
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,174.90
Typical High
$1,174.90
Midlands
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Midlands
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$1,862.09
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,047.13
Typical High
$1,380.38
United
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$602.56
Typical High
$870.96
United
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$794.33
Typical High
$1,318.26
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$1,071.52