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Michigan rates for HCPCS 77767

Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$64.81 / $64.81 / $64.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.75 / $279.95 / $279.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.16 / $374.49 / $449.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.08 / $326.47 / $536.24
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$41.46 / $41.46 / $64.81
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.05 / $206.46 / $305.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.49 / $188.33 / $261.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.99 / $256.63 / $352.87