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Montana rates for HCPCS 96522

Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.99 / $126.74 / $165.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.46 / $167.05 / $262.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.80 / $195.19 / $325.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.50 / $189.75 / $238.05