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Montana rates for HCPCS 50725

Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,445.44 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,737.80 / $1,862.09
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,905.46 / $2,089.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,905.46 / $2,089.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,584.89 / $2,089.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,122.02 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,862.09 / $2,754.23