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Utah rates for HCPCS 50920

Closure Ureterocutaneous Fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,248.55 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,128.29 / $1,248.55 / $1,999.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.93 / $1,258.99 / $1,911.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.98 / $644.14 / $857.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,144.45 / $1,707.64 / $2,008.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,312.00 / $2,446.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.19 / $1,016.02 / $1,830.96