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Montana rates for HCPCS 64643

Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $102.33 / $363.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $125.89 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $109.65 / $147.91
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $147.91 / $165.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $147.91 / $165.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $107.15 / $181.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $123.03 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $131.83 / $169.82