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Montana rates for HCPCS 50075

Nephrolithotomy Rmvl Large Staghorn Calculus

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,832.35 / $7,660.09 / $7,660.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,274.09 / $2,274.09 / $2,274.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,676.93 / $2,274.09 / $2,435.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,123.80 / $2,731.95 / $2,791.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,374.55 / $2,062.04 / $2,974.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,143.53 / $2,483.90 / $3,957.13