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Montana rates for HCPCS 64491

Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 2nd Level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,164.15 / $1,164.15 / $1,348.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.53 / $93.28 / $5,721.86
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$82.64 / $87.28 / $452.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.54 / $92.54 / $153.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.54 / $92.54 / $92.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.15 / $101.27 / $155.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.98 / $75.73 / $104.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.73 / $116.53 / $187.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $154.33 / $174.07