go back

Montana rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,194.74 / $4,995.04 / $4,995.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,487.49 / $1,487.49 / $1,487.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.64 / $1,487.49 / $1,585.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.79 / $1,762.80 / $1,807.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.07 / $1,345.74 / $1,941.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.12 / $1,644.61 / $2,584.44