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Maine rates for HCPCS 50525

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,857.94 / $1,857.94 / $2,013.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,783.47 / $23,063.27 / $26,006.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.20 / $1,961.52 / $3,024.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,567.35 / $2,193.89 / $3,143.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,644.87 / $2,118.46 / $3,249.82
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,857.94 / $1,857.94 / $2,013.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,440.01 / $2,004.57 / $2,863.04