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West Virginia rates for HCPCS 69604

Revision mastoidectomy; resulting in tympanoplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $3,548.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,071.52 / $1,584.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,380.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,548.82 / $6,025.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $1,819.70