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Montana rates for HCPCS 52001

Cysto W/Irrig & Evac Multple Obstructing Clots

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,342.73 / $6,342.73 / $6,342.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.25 / $415.30 / $1,492.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.35 / $445.35 / $445.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.35 / $481.90 / $691.43
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.81 / $700.70 / $721.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.62 / $461.61 / $710.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.83 / $700.70 / $1,211.74