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Montana rates for HCPCS 79101

Radiopharmaceutical therapy, by intravenous administration

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.53 / $155.96 / $857.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.83 / $58.39 / $298.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.60 / $144.60 / $229.25
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$144.60 / $144.60 / $178.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.16 / $208.04 / $288.36
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$66.58 / $84.65 / $106.36
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$144.60 / $144.60 / $178.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.08 / $198.44 / $269.37
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.18 / $84.65 / $103.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.76 / $140.41 / $405.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.17 / $51.08 / $148.00