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Pennsylvania rates for HCPCS 77750

Infusion or instillation of radioelement solution (includes 3-month follow-up care)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$255.84 / $445.16 / $892.88
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$298.81 / $298.81 / $298.81
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$255.84 / $485.26 / $1,010.57
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$298.81 / $298.81 / $298.81
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$247.27 / $258.10 / $258.10