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Hawaii rates for HCPCS 50526

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,737.80 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,698.24 / $1,905.46
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,238.72 / $2,691.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,698.24 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,905.46 / $2,454.71
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $1,479.11 / $2,290.87