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Montana rates for HCPCS 50722

Ureterolysis For Ovarian Vein Syndrome

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,063.23 / $1,311.97 / $5,379.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,610.53 / $1,610.53 / $1,610.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,158.73 / $1,610.53 / $1,724.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.17 / $1,841.45 / $1,940.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.29 / $1,466.09 / $2,114.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,550.64 / $1,789.20 / $2,819.39