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Montana rates for HCPCS 22586

Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,224.64 / $2,722.41 / $10,174.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,258.91 / $3,258.91 / $3,258.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,291.24 / $3,258.91 / $3,439.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,605.30 / $1,725.14 / $3,258.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,876.73 / $3,254.61 / $4,225.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,118.50 / $3,216.69 / $3,707.09