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Montana rates for HCPCS 64612

Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$753.62 / $753.62 / $753.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.36 / $157.71 / $267.58
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$220.04 / $704.52 / $993.59
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
$160.88 / $189.29 / $218.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.29 / $189.29 / $189.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.60 / $189.29 / $218.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.99 / $134.03 / $220.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.37 / $195.58 / $263.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.82 / $225.38 / $277.02