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Virginia rates for HCPCS 50920

Closure of ureterocutaneous fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$995.79 / $4,771.00 / $9,539.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.48 / $995.79 / $1,091.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,604.05 / $10,127.70 / $14,105.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.26 / $1,033.58 / $1,417.56
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.28 / $1,134.86 / $1,975.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.07 / $1,176.83 / $2,190.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$837.89 / $1,005.47 / $1,240.08
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.47 / $1,227.41 / $1,712.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.00 / $1,271.00 / $2,055.10
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$866.77 / $1,181.01 / $2,218.48
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.77 / $1,181.01 / $2,218.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,547.00 / $3,130.00 / $5,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.42 / $1,179.99 / $1,936.57