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West Virginia rates for HCPCS 69637

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,390.30 / $1,390.30 / $3,550.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,443.68 / $1,581.50 / $1,723.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,573.68 / $1,573.68 / $1,573.68