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Montana rates for HCPCS 49452

Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $691.83 / $1,548.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $660.69 / $1,905.46
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $1,288.25 / $1,513.56
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $1,288.25 / $1,513.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $724.44 / $1,905.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $346.74 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $549.54 / $1,621.81