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Montana rates for HCPCS 58672

Laparoscopy, surgical; with fimbrioplasty

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.19 / $3,843.51 / $3,843.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,156.76 / $1,156.76 / $1,156.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.52 / $1,156.76 / $1,214.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.04 / $1,300.65 / $1,369.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$704.58 / $1,056.98 / $1,524.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.51 / $1,278.59 / $2,027.60