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Montana rates for HCPCS 22862

Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,884.03 / $5,623.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,884.03 / $3,801.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,981.07 / $4,168.69
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,981.07 / $4,168.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,951.21 / $4,168.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,630.27 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,715.35 / $4,365.16