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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

Facilitymedian $1,072 · 10th–90th $437$1,6980%20%10th90th$1,072Professionalmedian $550 · 10th–90th $437$9550%20%40%10th90th$550$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $1,698.24 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $537.03 / $912.01
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $794.33 / $794.33
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $870.96 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $707.95
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,412.54 / $2,041.74
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,071.52
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $758.58 / $1,071.52
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $794.33 / $851.14
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $794.33
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $537.03 / $794.33
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $1,659.59
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $758.58 / $1,000.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,023.29
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $1,318.26 / $1,513.56
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $524.81 / $1,071.52