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Montana rates for HCPCS 0101T

Extracorporeal shock wave involving musculoskeletal system, not otherwise specified

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $199.53 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $257.04 / $288.40
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $316.23 / $9,120.11
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $316.23 / $9,120.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $165.96 / $288.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $245.47 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $457.09 / $524.81