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Montana rates for HCPCS 0216T

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $186.21 / $204.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $269.15 / $302.00
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $331.13 / $2,570.40
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $331.13 / $2,570.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $181.97 / $302.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $269.15 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $338.84