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Missouri 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
$1,701.89 / $4,470.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,357.86 / $1,687.34 / $1,722.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,490.00 / $11,288.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,418.00 / $1,744.19 / $2,728.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.07 / $2,164.12 / $3,649.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$958.00 / $2,308.46 / $7,903.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,557.95 / $2,701.11 / $10,618.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.00 / $2,693.00 / $10,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,526.31 / $2,286.75 / $4,206.43