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Montana rates for HCPCS 64495

Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 3+ Level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.61 / $1,030.61 / $1,030.61
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,004.86 / $1,004.86 / $1,132.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.64 / $85.93 / $407.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$129.26 / $142.82 / $395.44
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
$80.97 / $80.97 / $143.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.97 / $80.97 / $80.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.68 / $88.46 / $143.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $69.56 / $95.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.81 / $105.19 / $173.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.91 / $143.63 / $161.93