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Michigan rates for HCPCS 77763

Intracavitary radiation source application; complex

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.44 / $891.36 / $891.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.96 / $891.36 / $891.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.54 / $806.37 / $1,429.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.45 / $1,191.67 / $1,608.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.59 / $918.17 / $1,729.71
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.44 / $550.60 / $891.36
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.60 / $727.41 / $1,119.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.23 / $476.85 / $896.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.87 / $838.57 / $1,130.68