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Montana rates for HCPCS 50976

Ureteral Endosc Via Ureterot W/Dest&/Inc W/Wo Bx

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.91 / $2,441.69 / $2,441.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.92 / $721.92 / $721.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.00 / $721.92 / $781.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.74 / $878.80 / $895.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.73 / $655.16 / $945.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.52 / $807.61 / $1,255.22