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Montana rates for HCPCS 53452

Periurethral transperineal adjustable balloon continence device; unilateral insertion, including cystourethroscopy and imaging guidance

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $478.63 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $794.33
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $794.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $478.63 / $691.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $851.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $645.65 / $933.25