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West Virginia rates for HCPCS 39503

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $6,025.60 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $5,754.40 / $6,456.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $6,165.95 / $7,585.78
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $6,760.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $9,772.37 / $9,772.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $8,128.31 / $30,902.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $6,025.60 / $9,549.93