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Montana rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,449.54 / $6,064.54 / $6,064.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,802.44 / $1,802.44 / $1,802.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,308.39 / $1,802.44 / $1,927.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.05 / $2,161.25 / $2,210.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.93 / $1,632.06 / $2,354.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,732.12 / $2,111.17 / $3,133.90