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Montana 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
$1,936.13 / $7,572.89 / $7,572.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,321.92 / $2,321.92 / $2,321.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,501.57 / $2,321.92 / $2,548.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,145.92 / $2,583.10 / $2,712.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.78 / $2,132.89 / $3,076.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,825.57 / $1,825.57 / $1,825.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,026.74 / $2,527.56 / $4,063.51