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Maryland rates for HCPCS 50920

Closure of ureterocutaneous fistula

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.62 / $935.96 / $4,637.97
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.28 / $1,013.28 / $1,158.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.04 / $1,186.93 / $2,739.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.96 / $1,207.58 / $1,928.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.32 / $1,100.69 / $2,105.87
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.24 / $1,044.15 / $1,298.31