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Montana rates for HCPCS 22515

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.75 / $1,140.32 / $4,864.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.14 / $373.06 / $4,532.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.14 / $339.14 / $339.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.48 / $384.70 / $7,189.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.23 / $339.14 / $2,656.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.27 / $2,990.76 / $6,604.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,384.07 / $6,334.21 / $8,057.59