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Montana rates for HCPCS 57296

Revision (including removal) of prosthetic vaginal graft; open abdominal approach

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.31 / $4,961.67 / $4,961.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,517.46 / $1,517.46 / $1,517.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.06 / $1,517.46 / $1,547.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$744.20 / $1,680.90 / $1,769.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.59 / $1,385.53 / $1,998.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.86 / $1,616.61 / $2,661.21