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Montana rates for HCPCS L2624

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.00 / $1,435.16 / $1,435.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.32 / $364.32 / $364.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.02 / $391.71 / $391.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.02 / $318.55 / $391.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.99 / $373.06 / $391.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.02 / $294.00 / $392.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.05 / $211.05 / $232.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.22 / $186.11 / $213.05