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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
$152.13 / $250.13 / $275.14
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.76 / $82.56 / $140.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.12 / $145.12 / $247.13
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$145.12 / $145.12 / $179.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.77 / $372.39 / $585.26
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.01 / $133.94 / $218.04
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$145.12 / $145.12 / $179.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.02 / $268.70 / $407.26
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.82 / $145.12 / $171.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.93 / $264.55 / $373.46
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.87 / $99.97 / $175.57