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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
$704.78 / $2,951.65 / $2,951.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.72 / $870.72 / $870.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.67 / $870.72 / $944.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.87 / $1,066.00 / $1,084.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.95 / $792.01 / $1,142.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.41 / $976.20 / $1,518.85