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Prosthetic Knee, Exoskeletal Four-Bar, Pneumatic Swing

Wisconsin 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 $2,089 · 10th–90th $1,585$3,8020%50%10th90th$2,089Professionalmedian $1,950 · 10th–90th $1,023$3,4670%10%20%10th90th$1,950$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
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$2,041.74
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,089.30
Median
$2,089.30
Typical High
$3,467.37
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,344.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$4,786.30
Typical High
$10,471.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$3,019.95
Typical High
$3,890.45
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,659.59
Typical High
$2,570.40
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,995.26
Typical High
$2,454.71
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$2,041.74
Typical High
$9,549.93
Medica
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,288.25
Typical High
$2,290.87
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$1,380.38
Network Health
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$3,311.31
Typical High
$3,311.31
Network Health
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$2,344.23
Typical High
$4,073.80
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,659.59
Typical High
$2,570.40
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,995.26
Typical High
$2,041.74
Quartz
Setting
Professional
Modifier
Global
Typical Low
$2,089.30
Median
$3,090.30
Typical High
$5,495.41
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$4,265.80
Typical High
$9,772.37
Quartz
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$3,090.30
Typical High
$15,135.61
United
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,380.38
Typical High
$2,089.30
United
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,071.52
Typical High
$1,862.09