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Pennsylvania rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $5,754.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,202.26 / $2,454.71
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,412.54 / $2,187.76
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $1,659.59
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,380.38 / $2,137.96
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,265.80 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,412.54 / $3,162.28
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,187.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,862.09 / $2,511.89
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,318.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $1,071.52 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,288.25 / $2,238.72