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Montana rates for HCPCS 0657T

Anterior lumbar or thoracolumbar vertebral body tethering; 8 or more vertebral segments

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,365.53 / $2,510.46 / $2,510.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,657.46 / $3,657.46 / $3,657.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,657.46 / $3,657.46 / $3,657.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,398.56 / $1,398.56 / $3,657.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,657.46 / $3,657.46 / $4,876.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,361.41 / $3,822.77 / $4,218.24