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Prosthetic Knee, Exoskeletal Four-Bar, Pneumatic Swing

Pennsylvania rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Rates data updated July 2026.

Facilitymedian $3,467 · 10th–90th $891$13,4900%10%20%10th90th$3,467Professionalmedian $977 · 10th–90th $813$1,6980%20%40%10th90th$977$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$891.25
Median
$891.25
Typical High
$3,467.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$977.24
Typical High
$1,513.56
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
$1,122.02
Median
$1,621.81
Typical High
$2,041.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$2,818.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$1,318.26
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,630.27
Typical High
$3,890.45
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,412.54
Typical High
$2,041.74
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$3,467.37
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$977.24
Typical High
$1,621.81
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,047.13
Typical High
$1,047.13
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$9,772.37
Typical High
$15,848.93
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,905.46
Median
$1,949.84
Typical High
$1,949.84
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$2,454.71
Typical High
$2,454.71
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,122.02
Typical High
$2,089.30