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Ohio rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,094.48 / $4,723.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.33 / $1,094.48 / $2,174.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,315.00 / $8,450.20 / $15,206.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.28 / $1,186.21 / $2,137.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,038.67 / $1,246.40 / $1,542.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.54 / $1,142.54 / $1,151.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.20 / $1,454.14 / $2,237.92
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.67 / $1,574.56 / $2,181.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.97 / $1,085.03 / $1,520.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,480.00 / $3,086.00 / $6,111.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.58 / $1,425.04 / $2,438.67