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Maine rates for HCPCS 50520

Closure of nephrocutaneous or pyelocutaneous fistula

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,412.54 / $2,570.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,197.01 / $19,498.45 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,778.28 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,584.89 / $2,511.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $2,290.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,479.11 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,584.89 / $2,398.83