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Utah 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
$1,949.84 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,995.26 / $3,235.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,630.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,691.53 / $3,311.31
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,884.03 / $4,168.69
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,511.89 / $3,467.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,698.24 / $3,311.31