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Indiana rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,025.51 / $1,294.00 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.51 / $1,094.48 / $1,445.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,800.00 / $11,044.01 / $15,154.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,143.04 / $1,471.30 / $2,030.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,019.26 / $1,299.05 / $1,498.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.27 / $1,149.16 / $1,498.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.38 / $1,435.11 / $2,394.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $5,242.00 / $10,843.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,057.32 / $1,321.04 / $2,125.87