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Montana rates for HCPCS 22614

Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.26 / $694.26 / $694.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$615.19 / $615.19 / $615.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.14 / $416.81 / $615.19