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Montana rates for HCPCS 77772

Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.04 / $888.75 / $3,730.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.15 / $441.15 / $1,427.02
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$441.15 / $441.15 / $545.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.05 / $1,103.64 / $1,767.61
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$441.15 / $441.15 / $545.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.84 / $1,192.04 / $1,682.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.90 / $1,187.31 / $1,619.99