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West Virginia rates for HCPCS 50520

Closure of nephrocutaneous or pyelocutaneous fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.91 / $1,130.91 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.95 / $1,167.05 / $1,309.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,234.54 / $1,407.01 / $1,532.97
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,362.64 / $1,362.64 / $1,362.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,321.30 / $1,321.30 / $1,321.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.30 / $1,703.30 / $6,678.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.00 / $690.00 / $690.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.88 / $1,226.36 / $1,874.62