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Knee Orthosis, Single Upright, Custom Fitted

Utah 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 $479 · 10th–90th $309$1,0960%20%40%10th90th$479Professionalmedian $617 · 10th–90th $309$4,5710%10%10th90th$617$50.0$100.0$200.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$575.44
Typical High
$4,570.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$707.95
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$794.33
Typical High
$1,047.13
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,096.48
Typical High
$1,096.48
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$776.25
Typical High
$1,174.90
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02
Select Health
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$1,071.52
Typical High
$1,122.02
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,122.02
Typical High
$1,288.25
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$478.63
Typical High
$1,000.00
United
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$478.63
Typical High
$741.31