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Montana rates for HCPCS L2630

Addition to lower extremity, pelvic control, band and belt, unilateral

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $194.98 / $269.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $389.05 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $316.23 / $389.05
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $363.08 / $707.95
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $363.08 / $707.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $338.84 / $426.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $295.12 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $158.49 / $173.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $138.04 / $165.96