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Montana rates for HCPCS 64490

Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 1 Level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.75 / $537.75 / $1,837.28
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$537.75 / $537.75 / $4,090.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.18 / $192.28 / $5,721.86
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$98.04 / $815.38 / $6,070.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.10 / $165.10 / $304.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.10 / $165.10 / $165.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.92 / $178.20 / $314.86
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.67 / $148.94 / $204.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.60 / $217.00 / $372.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.43 / $308.95 / $346.89