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Montana rates for HCPCS 64605

Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $645.65 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $588.84 / $1,230.27
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $977.24 / $1,584.89
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $977.24 / $1,584.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $691.83 / $1,230.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $660.69 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $794.33 / $1,174.90