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Arkansas rates for HCPCS 77300

Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$35.19 / $42.03 / $52.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.96 / $69.88 / $665.55
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.63 / $35.19 / $186.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.67 / $35.34 / $63.06
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.30 / $101.30 / $117.70
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.99 / $49.48 / $54.24
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.16 / $50.16 / $50.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.17 / $86.26 / $95.84
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.47 / $44.32 / $49.24
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.69 / $41.94 / $46.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.78 / $103.62 / $149.41
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.54 / $49.04 / $68.50
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.83 / $50.72 / $76.64
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.50 / $116.50 / $135.36
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.29 / $59.72 / $69.38
Qualchoice
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$57.68 / $57.68 / $57.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.97 / $87.46 / $123.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.20 / $35.81 / $60.41
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.83 / $44.26 / $61.72