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Montana rates for HCPCS C2634

Brachytherapy source, nonstranded, high activity, iodine-125, greater than 1.01 mCi (NIST), per source

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $213.80
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $489.78 / $549.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $489.78 / $549.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $104.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $85.11