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West Virginia rates for HCPCS L5828

Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,778.28 / $2,951.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $4,570.88
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $4,073.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $6,025.60 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $18,197.01
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,238.72 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,238.72 / $2,884.03