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California rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $10,471.29 / $22,908.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,318.26 / $5,888.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,918.31 / $11,481.54 / $18,620.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,737.80 / $3,467.37
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $100.00 / $6,025.60
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,621.81 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,380.38 / $3,019.95
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,096.48 / $1,348.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $2,187.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $8,709.64
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,943.28 / $9,120.11 / $9,120.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,479.11 / $2,290.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $2,884.03
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,258.93 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $6,165.95 / $18,620.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $3,090.30