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Montana rates for HCPCS 50520

Closure of nephrocutaneous or pyelocutaneous fistula

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,525.40 / $5,976.25 / $5,976.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,833.46 / $1,833.46 / $1,833.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.92 / $1,833.46 / $1,833.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$905.04 / $1,922.05 / $1,971.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,121.25 / $1,682.05 / $2,426.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,440.87 / $1,440.87 / $1,440.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,586.24 / $1,991.24 / $3,208.83