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Maine rates for HCPCS 50526

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,819.70 / $3,467.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,197.01 / $19,498.45 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,398.83 / $3,235.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,137.96 / $3,388.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,238.72 / $3,090.30
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,995.26 / $4,168.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,089.30 / $3,235.94