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Utah 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
$60.72 / $60.72 / $60.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.85 / $238.85 / $906.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.41 / $298.20 / $453.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.45 / $157.15 / $232.89
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$439.86 / $439.86 / $439.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.79 / $413.10 / $454.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.69 / $305.86 / $403.74