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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
$788.40 / $3,996.10 / $3,996.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,209.86 / $1,209.86 / $1,209.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.14 / $1,209.86 / $1,234.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.60 / $1,355.90 / $1,395.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.08 / $1,098.23 / $1,584.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,063.85 / $1,312.20 / $2,105.29