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Knee Orthosis, Anterior Cruciate Ligament, Custom Fabricated

Wisconsin rates for HCPCS L1840

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

Rates data updated July 2026.

Facilitymedian $1,148 · 10th–90th $851$2,3440%20%40%10th90th$1,148Professionalmedian $1,072 · 10th–90th $562$1,9050%20%10th90th$1,072$1.0$5.0$20.0$100.0$500.0$2.0K

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
$575.44
Median
$575.44
Typical High
$575.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$1,023.29
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,905.46
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,071.52
Typical High
$1,258.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$2,691.53
Typical High
$5,888.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$1,659.59
Typical High
$2,187.76
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$933.25
Typical High
$1,445.44
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,659.59
Typical High
$2,089.30
Medica
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$1,122.02
Typical High
$5,495.41
Medica
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$602.56
Typical High
$1,288.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$354.81
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,819.70
Network Health
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,288.25
Typical High
$2,290.87
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$933.25
Typical High
$1,445.44
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$1,122.02
Typical High
$1,380.38
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,737.80
Typical High
$3,090.30
Quartz
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$2,344.23
Typical High
$5,623.41
Quartz
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$1,737.80
Typical High
$6,760.83
Security Health
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,047.13
Typical High
$1,071.52
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$616.60
Typical High
$1,148.15
United
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$562.34
Typical High
$1,047.13