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Utah rates for HCPCS 50520

Closure of nephrocutaneous or pyelocutaneous fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,258.93 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,479.11 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,238.72
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,995.26 / $2,454.71
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,137.96 / $3,019.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,862.09 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,818.38 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,258.93 / $2,454.71