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Montana rates for HCPCS 57330

Closure of vesicovaginal fistula; transvesical and vaginal approach

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,905.46
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
$851.14 / $1,202.26 / $1,230.27
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,318.26 / $1,548.82
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,318.26 / $1,548.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,023.29 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $794.33 / $1,584.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,258.93 / $1,862.09