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Arizona 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
$44.70 / $96.78 / $129.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.40 / $102.79 / $864.04
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.73 / $72.23 / $888.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$35.04 / $43.32 / $173.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.64 / $70.45 / $73.66
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.87 / $54.69 / $54.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.38 / $69.98 / $87.47
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.32 / $34.32 / $42.90
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.76 / $35.65 / $71.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.15 / $86.79 / $133.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.72 / $40.29 / $63.58
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$27.43 / $45.87 / $68.36
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$76.59 / $170.00 / $170.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.38 / $95.21 / $468.00
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.40 / $40.72 / $378.10
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$40.26 / $52.88 / $378.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.61 / $84.81 / $144.71
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.40 / $39.85 / $56.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$40.26 / $47.48 / $67.19