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Pennsylvania 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
$53.62 / $81.84 / $187.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.73 / $228.93 / $279.95
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.64 / $353.73 / $410.50
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$62.66 / $62.66 / $62.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.68 / $281.39 / $445.48
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.12 / $313.20 / $391.51
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.62 / $98.12 / $211.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.73 / $233.02 / $466.79
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.97 / $302.50 / $466.30
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$62.66 / $62.66 / $62.66
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.84 / $287.33 / $457.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.20 / $54.20 / $59.43
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.47 / $237.54 / $258.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.38 / $266.50 / $449.18