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Montana rates for HCPCS 15572

Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.14 / $1,498.77 / $4,668.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,164.65 / $1,164.65 / $1,164.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.18 / $1,243.73 / $1,466.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.04 / $865.61 / $1,642.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.45 / $1,188.36 / $1,660.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,285.85 / $1,467.40 / $1,603.52