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Wisconsin rates for HCPCS 77789

Surface application of low dose rate radionuclide source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$89.13 / $89.13 / $128.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$162.18 / $186.21 / $302.00
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$141.25 / $380.19 / $380.19