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Montana rates for HCPCS 50825

Continent diversion, including intestine anastomosis using any segment of small and/or large intestine (Kock pouch or Camey enterocystoplasty)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,070.98 / $8,692.44 / $8,692.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,568.53 / $2,568.53 / $2,568.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,891.65 / $2,568.53 / $2,765.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.01 / $3,084.90 / $3,162.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,553.45 / $2,330.41 / $3,361.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,488.73 / $2,871.60 / $4,471.45