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Montana rates for HCPCS 51050

Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,877.62 / $21,877.62 / $21,877.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $812.83 / $977.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $691.83 / $891.25