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Indiana 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
$1,659.59 / $2,344.23 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $3,019.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $19,054.61 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,737.80 / $2,754.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,548.82 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,862.09 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $5,754.40 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $2,754.23