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Maine rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,412.54 / $2,454.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $13,182.57 / $17,782.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,659.59 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,479.11 / $2,398.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,513.56 / $2,187.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,513.56 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,621.81 / $2,187.76