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Montana 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
$1,548.82 / $1,995.26 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,398.83 / $2,511.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $3,019.95
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $3,019.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $2,089.30 / $3,019.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,584.89 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $3,981.07