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Montana rates for HCPCS 50576

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $724.44 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $870.96 / $933.25
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $954.99 / $1,174.90
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $954.99 / $1,174.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $831.76 / $1,071.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $575.44 / $1,148.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $954.99 / $1,412.54