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Montana 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
Professional
Modifier
Low / Median / High Price
$200.73 / $206.46 / $906.40
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.23 / $86.23 / $106.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.06 / $273.35 / $435.68
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.23 / $86.23 / $106.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.83 / $313.50 / $457.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.20 / $305.86 / $688.20