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Montana rates for HCPCS 77387

Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.93 / $564.17 / $929.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.03 / $60.53 / $160.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.94 / $171.94 / $171.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.48 / $155.90 / $438.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.51 / $84.13 / $201.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.48 / $155.90 / $438.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.01 / $171.86 / $240.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.56 / $123.15 / $173.02