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Montana rates for HCPCS 58572

Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,621.05 / $4,621.05 / $4,621.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,606.84 / $1,606.84 / $1,606.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.08 / $2,018.90 / $2,135.32