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Montana rates for HCPCS 22862

Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,536.78 / $3,095.47 / $11,594.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,708.99 / $3,708.99 / $3,708.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,761.90 / $2,951.32 / $3,708.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,825.77 / $2,510.42 / $3,708.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,073.89 / $3,419.60 / $4,812.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,004.40 / $3,674.00 / $4,233.78