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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Virginia rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,175 · 10th–90th $575$1,4450%20%40%10th90th$1,175Professionalmedian $617 · 10th–90th $479$1,0960%20%40%10th90th$617$1.0$5.0$20.0$100.0$500.0$2.0K$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
$575.44
Typical High
$575.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$575.44
Typical High
$616.60
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,258.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$1,380.38
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$741.31
Typical High
$741.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$724.44
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,174.90
Typical High
$1,659.59
Medcost
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$776.25
Typical High
$1,174.90
Medcost
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$776.25
Typical High
$1,380.38
Medcost
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$691.83
Typical High
$1,479.11
Sentara
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$977.24
Typical High
$2,570.40
Sentara
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$977.24
Typical High
$2,570.40
United
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$549.54
Typical High
$1,412.54
United
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$575.44
Typical High
$933.25