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New Hampshire rates for HCPCS 77770

Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$101.31 / $101.31 / $156.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.31 / $293.74 / $331.59
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.84 / $89.57 / $101.31
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$180.46 / $204.15 / $230.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.31 / $481.91 / $698.76
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.27 / $142.41 / $206.49
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.04 / $339.50 / $492.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.63 / $765.01 / $1,066.59
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.60 / $220.42 / $306.10
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$321.02 / $554.47 / $760.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.60 / $740.06 / $1,382.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.84 / $204.00 / $378.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$273.76 / $491.57 / $901.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.96 / $429.17 / $1,612.31
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.44 / $133.44 / $235.84
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$273.64 / $296.35 / $524.73
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.94 / $315.66 / $476.74
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.48 / $93.51 / $128.88
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.68 / $222.11 / $306.20