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Montana rates for HCPCS 0221T

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,230.27 / $1,445.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,905.46 / $2,089.30
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $19,952.62
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $19,952.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,380.38 / $2,089.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,905.46 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,187.76 / $2,511.89