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Montana rates for HCPCS 52005

Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $288.40 / $588.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $223.87 / $478.63
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $446.68 / $562.34
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $446.68 / $562.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $257.04 / $575.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $208.93 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $380.19 / $562.34