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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Vermont rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $676 · 10th–90th $389$7410%20%10th90th$676Professionalmedian $550 · 10th–90th $537$7410%20%40%10th90th$550$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
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$812.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$741.31
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$1,071.52
United
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$645.65
Typical High
$691.83
United
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$794.33
Typical High
$2,187.76