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Knee Orthosis, Single Upright, Custom Fitted

Pennsylvania rates for HCPCS L1843

Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Rates data updated July 2026.

Facilitymedian $1,698 · 10th–90th $437$5,6230%10%20%10th90th$1,698Professionalmedian $525 · 10th–90th $437$8910%20%40%10th90th$525$1.0$10.0$100.0$1.0K$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
$436.52
Median
$436.52
Typical High
$1,698.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$512.86
Typical High
$758.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$794.33
Typical High
$794.33
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$870.96
Typical High
$1,071.52
Cigna
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$1,513.56
Cigna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$707.95
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,412.54
Typical High
$2,041.74
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$1,071.52
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$758.58
Typical High
$1,071.52
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$794.33
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$1,698.24
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$524.81
Typical High
$891.25
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$3,801.89
Typical High
$6,165.95
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$1,000.00
Typical High
$1,023.29
United
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$1,318.26
Typical High
$1,318.26
United
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$524.81
Typical High
$1,071.52