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West Virginia rates for HCPCS 30920

Ligation Arteries Int Maxillary Transantral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.75 / $843.75 / $1,700.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.75 / $855.11 / $1,069.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$903.92 / $995.12 / $1,084.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.73 / $963.73 / $963.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$982.00 / $982.00 / $982.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$847.23 / $1,204.66 / $4,214.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.49 / $1,006.99 / $1,358.42