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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
$1,584.89 / $2,137.96 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $4,073.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $4,073.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,754.23 / $3,630.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $3,801.89 / $4,365.16