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Montana rates for HCPCS 50125

Pyelotomy; with drainage, pyelostomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,548.82 / $1,659.59
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $1,862.09
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $1,862.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,513.56 / $1,862.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,000.00 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $2,454.71