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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
$2,073.25 / $8,113.96 / $8,113.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,485.46 / $2,485.46 / $2,485.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,583.91 / $2,485.46 / $2,485.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,226.64 / $2,529.80 / $2,635.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,522.07 / $2,283.34 / $3,293.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,158.71 / $2,663.95 / $4,352.10