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Montana rates for HCPCS 58752

Tubouterine implantation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,071.52 / $2,238.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,445.44 / $1,445.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,584.89 / $1,737.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,584.89 / $1,737.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,258.93 / $1,548.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $954.99 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,513.56 / $2,238.72