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Utah rates for HCPCS 50930

Closure Ureterocutaneous Fistula W/Visc Rpr

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,649.71 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,404.35 / $1,649.71 / $2,495.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,322.41 / $1,597.95 / $2,047.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.79 / $779.85 / $1,024.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,424.68 / $2,246.11 / $2,754.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,312.00 / $2,446.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.39 / $1,274.01 / $2,291.76