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Knee Orthosis, Single Upright, Custom Fitted

Wisconsin 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 $1,096 · 10th–90th $759$1,9950%50%10th90th$1,096Professionalmedian $1,023 · 10th–90th $513$1,6980%20%10th90th$1,023$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
$169.82
Median
$169.82
Typical High
$549.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$870.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,819.70
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,230.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$2,511.89
Typical High
$5,623.41
Cigna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$1,584.89
Typical High
$2,089.30
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$891.25
Typical High
$1,348.96
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,318.26
Typical High
$1,659.59
Medica
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$1,071.52
Typical High
$5,011.87
Medica
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$562.34
Typical High
$1,202.26
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$416.87
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80
Network Health
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,230.27
Typical High
$2,137.96
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$891.25
Typical High
$1,348.96
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$1,047.13
Typical High
$1,071.52
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,659.59
Typical High
$2,884.03
Quartz
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$2,238.72
Typical High
$5,128.61
Quartz
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$1,659.59
Typical High
$5,495.41
Security Health
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,000.00
Typical High
$1,023.29
United
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$562.34
Typical High
$1,096.48
United
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$537.03
Typical High
$1,000.00