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West Virginia rates for HCPCS 51065

Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $588.84 / $1,096.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $741.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $9,772.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $630.96 / $1,023.29