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Maryland rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,116.61 / $1,164.88 / $5,795.08
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,266.71 / $1,377.13 / $1,574.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.81 / $1,550.62 / $3,514.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.23 / $1,501.88 / $2,401.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.57 / $1,340.04 / $2,376.81
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.42 / $1,298.60 / $1,615.32