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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
$1,260.31 / $4,470.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.49 / $1,249.54 / $1,275.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,449.00 / $10,043.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.40 / $1,354.75 / $2,162.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.17 / $1,654.95 / $2,883.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.40 / $1,822.83 / $7,072.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.45 / $2,000.82 / $8,172.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.00 / $3,233.00 / $11,343.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.73 / $1,666.16 / $3,009.66