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Montana rates for HCPCS G0276

Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (PILD) or placebo-control, performed in an approved coverage with evidence development (CED) clinical trial

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.88 / $485.00 / $1,976.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.75 / $575.75 / $575.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.56 / $575.75 / $668.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.67 / $339.96 / $575.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.20 / $575.75 / $788.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.71 / $627.55 / $753.06