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Wisconsin 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
$396.16 / $396.16 / $560.50
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$697.47 / $815.05 / $1,250.30
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,205.01 / $1,205.01 / $1,205.01