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Montana rates for HCPCS 58674

Laparoscopy, surgical, ablation of uterine fibroid(s) including intraoperative ultrasound guidance and monitoring, radiofrequency

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,374.95 / $10,374.95 / $10,374.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.88 / $1,256.05 / $4,276.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.68 / $1,287.68 / $1,287.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,287.68 / $1,287.68 / $1,287.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.95 / $1,287.68 / $1,287.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$631.87 / $789.84 / $1,287.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.19 / $1,174.91 / $1,694.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,184.73 / $1,468.16 / $2,257.92