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Montana rates for HCPCS C2639

Brachytherapy source, nonstranded, iodine-125, per source

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $26.92 / $34.67
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $107.15 / $112.20
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $107.15 / $112.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $27.54 / $27.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $85.11