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Indiana rates for HCPCS 50525

Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; abdominal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,339.46 / $1,596.82 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,339.46 / $1,480.02 / $1,888.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,091.00 / $15,580.56 / $24,062.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,384.97 / $1,752.70 / $2,418.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,324.19 / $1,687.70 / $1,947.35
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.23 / $1,492.96 / $1,947.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,396.56 / $1,833.31 / $3,083.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,917.00 / $5,660.00 / $11,929.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.17 / $1,658.27 / $3,315.36