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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Utah rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $513 · 10th–90th $331$1,0470%20%40%10th90th$513Professionalmedian $617 · 10th–90th $331$6,0260%10%10th90th$617$50.0$100.0$200.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$562.34
Typical High
$6,025.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$758.58
Typical High
$977.24
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,047.13
Typical High
$1,047.13
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$741.31
Typical High
$1,348.96
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,047.13
Typical High
$1,047.13
Select Health
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$1,047.13
Typical High
$1,230.27
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,047.13
Typical High
$1,479.11
United
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$645.65
Typical High
$954.99
United
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$512.86
Typical High
$794.33