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Montana rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,384.75 / $5,795.08 / $5,795.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.47 / $1,721.47 / $1,721.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,266.15 / $1,721.47 / $1,842.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.27 / $2,113.15 / $2,194.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.41 / $1,559.27 / $2,249.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,655.16 / $1,885.58 / $2,997.01