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Wisconsin rates for HCPCS L5614

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

Facilitymedian $2,089 · 10th–90th $1,698$3,8020%50%10th90th$2,089Professionalmedian $1,514 · 10th–90th $891$3,0900%10%20%10th90th$1,514$2.0$10.0$50.0$200.0$1.0K$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,023.29 / $1,698.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,089.30 / $3,467.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,949.84 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $4,786.30 / $10,232.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $2,951.21 / $3,890.45
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,659.59 / $2,570.40
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,995.26 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $2,041.74 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,288.25 / $2,290.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,380.38
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,311.31 / $3,311.31 / $3,311.31
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $2,344.23 / $4,073.80
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,090.30 / $5,754.40
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $4,168.69 / $9,549.93
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,905.46 / $15,135.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,380.38 / $2,089.30
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,023.29 / $1,698.24