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Utah rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,202.26 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $2,238.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,137.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,187.76 / $2,754.23
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,995.26 / $2,290.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,737.80 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,288.25 / $2,290.87