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Montana rates for HCPCS 50391

Instlj Ther Agent Renal Pelvis&/Ureter Via Tub

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.13 / $447.00 / $651.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.47 / $152.47 / $152.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.47 / $165.87 / $203.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.64 / $234.00 / $239.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.89 / $153.66 / $211.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.60 / $213.00 / $342.24