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West Virginia rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.19 / $290.19 / $290.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.19 / $290.19 / $383.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.66 / $798.90 / $1,035.61
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.66 / $414.25 / $710.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $768.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $3,221.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.24 / $412.42 / $494.28