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Montana rates for HCPCS 64494

Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 2nd Level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,105.15 / $1,105.15 / $1,517.69
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$828.00 / $1,210.33 / $2,274.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.93 / $92.97 / $1,126.80
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$73.41 / $139.50 / $408.83
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
$79.40 / $79.40 / $143.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.40 / $79.40 / $79.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.50 / $87.30 / $143.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.28 / $70.33 / $96.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.48 / $103.81 / $172.90
Providence
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$25.87 / $27.32 / $38.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.91 / $141.68 / $163.03