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Montana rates for HCPCS 58573

Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $15,488.17 / $39,810.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,137.96 / $2,511.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,778.28 / $2,454.71