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Montana rates for HCPCS 50688

Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,897.56 / $2,897.56 / $2,897.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.20 / $120.78 / $414.44
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
$121.46 / $121.46 / $121.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.42 / $121.46 / $133.86
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.74 / $146.90 / $152.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $108.71 / $156.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.26 / $132.16 / $210.89