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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Washington rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,202 · 10th–90th $813$2,5120%20%10th90th$1,202Professionalmedian $1,000 · 10th–90th $537$2,0420%10%20%10th90th$1,000$10.0$50.0$200.0$1.0K$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
$812.83
Median
$812.83
Typical High
$1,905.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$812.83
Typical High
$6,025.60
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,174.90
Typical High
$1,202.26
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,047.13
Typical High
$1,348.96
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$1,548.82
Typical High
$3,388.44
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,348.96
Typical High
$2,398.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$831.76
Typical High
$1,000.00
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$1,174.90
Typical High
$1,202.26
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,202.26
Typical High
$1,202.26
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,737.80
Typical High
$2,398.83
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,174.90
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,202.26
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,047.13
Typical High
$1,348.96
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$1,412.54
Typical High
$1,698.24
United
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$602.56
Typical High
$977.24
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$1,047.13
Typical High
$1,819.70