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Montana rates for HCPCS G6004

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.71 / $142.19 / $770.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.51 / $109.51 / $199.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.12 / $151.38 / $199.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.56 / $182.15 / $252.26