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Montana rates for HCPCS 95873

Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.04 / $105.42 / $416.53
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.50 / $25.58 / $106.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.97 / $29.97 / $110.94
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$29.97 / $29.97 / $35.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.81 / $99.85 / $122.80
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.17 / $26.97 / $33.76
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$29.97 / $29.97 / $35.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.59 / $110.16 / $155.01
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.17 / $26.97 / $33.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.03 / $119.34 / $137.53
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.05 / $32.49 / $37.61