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Tennessee rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,821.00 / $3,018.57 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,062.07 / $1,353.62 / $1,468.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $2,326.00 / $4,528.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.90 / $1,403.44 / $2,469.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.79 / $1,545.92 / $2,418.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $8,757.14 / $8,952.86
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,994.16 / $8,172.88 / $9,114.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $2,665.00 / $4,918.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.14 / $1,555.62 / $2,593.91