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Montana rates for HCPCS 0072T

Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume greater or equal to 200 cc of tissue

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,584.89 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $891.25
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $8,709.64
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $8,709.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $933.25 / $2,187.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $891.25 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,235.94 / $4,570.88