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Missouri rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $4,897.79 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,258.93 / $2,137.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,786.30 / $10,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,348.96 / $2,089.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,122.02 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $1,548.82 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $1,862.09 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,778.28 / $8,128.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,818.38 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,548.82 / $2,511.89