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Montana rates for HCPCS 77763

Intracavitary Radiation Source Applic Complex

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.41 / $821.49 / $4,353.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.46 / $622.46 / $1,730.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.25 / $969.30 / $1,444.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.46 / $897.26 / $1,526.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.96 / $1,027.05 / $1,444.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.50 / $965.40 / $1,356.33