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Wisconsin rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,238.72 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,122.02 / $2,754.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,317.64 / $14,125.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,089.30 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $5,248.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $3,467.37 / $3,981.07
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $6,918.31 / $13,489.63
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,691.53 / $3,388.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $2,691.53 / $7,943.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,949.84 / $8,128.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,584.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,511.89 / $4,265.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $8,709.64 / $8,709.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $5,370.32 / $7,943.28
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $5,623.41
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $6,456.54 / $8,128.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,165.95 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,778.28 / $4,677.35