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Michigan rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,396.97 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.46 / $1,396.97 / $1,396.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,181.81 / $6,048.73 / $8,240.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.76 / $1,804.94 / $2,737.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.68 / $1,296.06 / $2,247.77
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.41 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,240.02 / $1,291.41 / $1,799.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.78 / $948.05 / $1,400.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.00 / $4,645.00 / $6,327.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,197.77 / $1,475.46 / $1,972.69