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Prosthetic Knee, Exoskeletal Four-Bar, Pneumatic Swing

Utah 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 $1,000 · 10th–90th $589$2,0420%20%40%10th90th$1,000Professionalmedian $1,288 · 10th–90th $589$8,7100%10%10th90th$1,288$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
$588.84
Median
$588.84
Typical High
$588.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$891.25
Typical High
$8,709.64
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,318.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$1,318.26
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$1,513.56
Typical High
$1,905.46
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$2,041.74
Typical High
$2,041.74
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,479.11
Typical High
$2,238.72
Select Health
Setting
Facility
Modifier
Global
Typical Low
$2,089.30
Median
$2,089.30
Typical High
$2,089.30
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$2,041.74
Typical High
$2,089.30
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$2,089.30
Typical High
$2,454.71
United
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$1,202.26
Typical High
$1,445.44
United
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$912.01
Typical High
$1,412.54