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Montana rates for HCPCS 50620

Urtrolithotomy Middle One-Third Ureter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,136.30 / $4,754.71 / $4,754.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,414.40 / $1,414.40 / $1,414.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.02 / $1,414.40 / $1,510.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.37 / $1,687.40 / $1,728.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.07 / $1,279.74 / $1,845.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,323.96 / $1,566.00 / $2,459.57