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Alaska rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,270.66 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,172.56 / $5,172.56 / $7,193.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,810.49 / $3,810.49 / $3,810.49
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,387.35 / $5,172.56 / $7,396.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,664.55 / $6,919.50 / $9,078.23
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,118.75 / $4,777.75 / $7,029.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,387.35 / $5,172.56 / $7,396.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,514.78 / $4,774.50 / $7,111.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,048.40 / $3,048.40 / $7,040.07