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Montana rates for HCPCS 92975

Thrombolysis, coronary; by intracoronary infusion, including selective coronary angiography

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,924.17 / $1,924.17 / $1,924.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.75 / $763.75 / $775.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.95 / $323.95 / $437.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.36 / $655.60 / $765.10