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Montana rates for HCPCS 52301

Cysto W/Resecj Ectopic Ureterocele Uni/Bi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,870.19 / $1,870.19 / $1,870.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.02 / $1,517.80 / $1,517.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.56 / $449.56 / $449.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.88 / $449.56 / $487.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.17 / $551.20 / $562.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.42 / $407.17 / $587.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.48 / $501.00 / $782.56