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Montana rates for HCPCS L2622

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.51 / $1,329.04 / $1,329.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.87 / $362.75 / $362.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.87 / $295.00 / $362.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.62 / $345.48 / $362.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.87 / $272.26 / $363.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.78 / $172.36 / $273.36