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West Virginia rates for HCPCS 50075

Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,479.11 / $2,511.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,862.09
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $2,454.71 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,041.74 / $9,120.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,659.59 / $2,570.40