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Montana rates for HCPCS 75630

Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $223.87 / $426.58
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $95.50 / $229.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $245.47
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$144.54 / $144.54 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $371.54 / $630.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $120.23 / $234.42
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $275.42 / $407.38
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$144.54 / $144.54 / $177.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $354.81 / $457.09
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $144.54 / $213.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $245.47 / $426.58
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $100.00 / $169.82