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Wisconsin 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
Facility
Modifier
26
Low / Median / High Price
$110.95 / $110.95 / $156.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.54 / $522.98 / $541.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.47 / $714.47 / $2,390.26
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$195.54 / $228.51 / $350.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.78 / $1,634.71 / $1,857.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.65 / $827.79 / $2,295.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.80 / $236.81 / $683.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.44 / $871.62 / $1,554.79
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$336.07 / $336.07 / $336.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.55 / $1,740.30 / $2,295.51
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,244.71 / $2,244.71 / $2,244.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.65 / $798.05 / $1,605.69