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Montana rates for HCPCS L8687

Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,439.90 / $8,439.90 / $8,439.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,551.49 / $7,551.49 / $13,765.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,551.49 / $7,551.49 / $13,498.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,979.44 / $11,948.04 / $25,295.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,551.49 / $12,458.62 / $16,173.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,515.01 / $5,558.95 / $13,897.38