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Montana rates for HCPCS 57308

Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.04 / $684.87 / $3,476.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.13 / $1,052.13 / $1,052.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.13 / $1,052.13 / $1,052.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.87 / $1,052.13 / $1,056.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518.54 / $1,120.59 / $1,201.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.67 / $953.61 / $1,375.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$828.23 / $828.23 / $828.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.99 / $1,120.59 / $1,837.05