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Montana rates for HCPCS 99455

Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.78 / $84.95 / $125.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.91 / $357.54 / $357.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.76 / $398.62 / $398.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.20 / $84.95 / $125.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.62 / $398.62 / $398.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.00 / $233.00 / $233.00