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Georgia rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,120.99 / $5,045.00 / $6,915.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.04 / $1,305.33 / $2,498.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,298.47 / $4,431.64 / $10,456.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.32 / $1,546.29 / $3,016.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.00 / $550.00 / $550.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,239.34 / $1,864.50 / $3,068.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,074.88 / $1,397.34 / $3,098.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.00 / $3,629.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,147.72 / $1,599.16 / $2,904.81