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Montana rates for HCPCS 55873

Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $4,570.88 / $11,748.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,318.26 / $11,748.98
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $9,772.37 / $11,748.98
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $9,772.37 / $11,748.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,698.24 / $10,471.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,288.25 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $3,162.28 / $11,748.98