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Montana rates for HCPCS 0102T

Extracorporeal shock wave performed by a physician, requiring anesthesia other than local, and involving the lateral humeral epicondyle

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $338.84 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $501.19 / $549.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $616.60 / $9,120.11
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $616.60 / $9,120.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $398.11 / $549.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $501.19 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $467.74 / $575.44