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Montana rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,230.27 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,479.11 / $1,584.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,621.81 / $1,819.70
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,621.81 / $1,819.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,380.38 / $1,778.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $977.24 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,621.81 / $2,344.23