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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
$1,023.29 / $1,318.26 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,621.81 / $1,737.80
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,778.28 / $1,949.84
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,778.28 / $1,949.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,548.82 / $1,949.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,047.13 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,778.28 / $2,570.40