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Louisiana rates for HCPCS 50920

Closure of ureterocutaneous fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $2,562.00 / $4,050.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.47 / $1,383.89 / $1,485.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.80 / $7,500.13 / $10,427.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,170.30 / $1,242.90 / $1,596.91
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.30 / $1,138.19 / $1,529.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.00 / $1,309.00 / $7,168.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.47 / $1,122.38 / $1,851.82