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Montana rates for HCPCS 58615

Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $302.00 / $630.96
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
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $407.38 / $407.38
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $446.68 / $501.19
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $446.68 / $501.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $363.08 / $436.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $263.03 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $416.87 / $616.60