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Washington, DC rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,137.96 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,202.26 / $3,311.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,230.27 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,479.11 / $3,162.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,071.52 / $2,454.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $2,344.23 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,445.44 / $2,691.53