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West Virginia rates for HCPCS 50715

Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,147.45 / $1,147.45 / $1,400.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,283.50 / $1,442.03 / $1,571.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,373.51 / $1,373.51 / $1,373.51
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$134.81 / $134.81 / $134.81
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,598.96 / $5,598.96 / $5,598.96