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New Hampshire rates for HCPCS 77316

Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$114.82 / $114.82 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $239.88 / $616.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $338.84 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $501.19 / $758.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $489.78 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $295.12 / $758.58
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.95 / $54.95 / $54.95