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West Virginia rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,038.08 / $1,038.08 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$974.23 / $1,094.48 / $1,250.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.02 / $1,295.93 / $1,411.94
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.06 / $1,255.06 / $1,255.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,249.66 / $1,249.66 / $1,249.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.58 / $1,568.82 / $6,867.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.16 / $1,281.78 / $1,870.51