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Montana rates for HCPCS 58750

Tubotubal anastomosis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.55 / $4,760.43 / $4,760.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,441.74 / $1,441.74 / $1,441.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.43 / $1,441.74 / $1,508.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.76 / $1,593.15 / $1,678.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.98 / $1,317.10 / $1,899.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,250.00 / $1,568.63 / $2,525.23