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Montana rates for HCPCS 61791

Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.50 / $5,655.79 / $5,655.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,813.48 / $1,813.48 / $1,813.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.83 / $1,813.48 / $1,942.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$894.58 / $1,864.20 / $2,017.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.96 / $1,630.61 / $2,352.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,409.27 / $1,409.27 / $3,905.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,525.15 / $1,882.10 / $3,159.80