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Wisconsin rates for HCPCS 77789

Surface Applic Low Dose Rate Radionuclide Source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$90.48 / $90.48 / $127.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$160.40 / $187.44 / $287.54
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$274.01 / $274.01 / $274.01