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Illinois rates for HCPCS 50930

Closure Ureterocutaneous Fistula W/Visc Rpr

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,108.78 / $2,084.35 / $5,549.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.78 / $1,131.58 / $2,119.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,109.44 / $17,346.40 / $34,736.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.69 / $2,148.16 / $2,315.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,183.66 / $1,563.42 / $2,280.44
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,173.00 / $1,852.94 / $5,047.22
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.52 / $1,386.27 / $1,505.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,737.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.00 / $2,873.00 / $7,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,179.52 / $1,678.99 / $2,726.18