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Montana rates for HCPCS 50130

Pyelotomy With Removal Calculus

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,299.20 / $5,433.88 / $5,433.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,615.78 / $1,615.78 / $1,615.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.14 / $1,615.78 / $1,726.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$799.35 / $1,929.85 / $1,977.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.35 / $1,463.18 / $2,110.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,402.00 / $1,789.80 / $2,811.07