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Montana rates for HCPCS 77412

Radiation treatment delivery; Level 3, multiple isocenters with photon therapy (eg, 2D, 3D, or IMRT) or a single-isocenter photon therapy (eg, 3D or IMRT) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $870.96 / $1,479.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $346.74 / $645.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $446.68 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $363.08 / $707.95
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $407.38 / $794.33
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $407.38 / $794.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $426.58 / $851.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $251.19 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $346.74 / $446.68