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Montana rates for HCPCS 59121

Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.56 / $867.25 / $4,139.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.41 / $1,302.41 / $1,302.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,302.41 / $1,302.41 / $1,302.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.44 / $1,302.41 / $1,340.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.71 / $1,396.20 / $1,481.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.72 / $1,181.71 / $1,704.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.44 / $1,374.72 / $2,277.34