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Montana rates for HCPCS 74775

Perineogram

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.36 / $261.70 / $291.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.38 / $127.24 / $180.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.66 / $127.24 / $190.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.38 / $157.30 / $265.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.29 / $123.68 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.04 / $264.89 / $465.21