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Montana rates for HCPCS 77768

Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.45 / $292.45 / $388.04
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$115.15 / $115.15 / $142.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.08 / $429.54 / $682.57
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$115.15 / $115.15 / $142.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.77 / $481.65 / $682.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.31 / $458.61 / $643.94