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Iowa 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
$30.53 / $92.70 / $154.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.40 / $361.00 / $2,214.05
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.59 / $210.66 / $986.67
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$35.34 / $63.06 / $940.00
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$98.13 / $101.07 / $104.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.93 / $156.69 / $195.86
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.26 / $76.02 / $95.02
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.69 / $80.67 / $100.84
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.82 / $101.72 / $221.82
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.59 / $50.10 / $168.49
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.23 / $49.95 / $79.87
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$101.07 / $101.07 / $101.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.50 / $116.23 / $309.52
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.39 / $43.14 / $378.10
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.02 / $46.39 / $378.10
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$101.07 / $104.02 / $181.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.28 / $143.75 / $192.59
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.63 / $60.62 / $112.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.41 / $84.86 / $124.25
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.39 / $41.89 / $62.09
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.02 / $42.13 / $63.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.36 / $124.50 / $146.40
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.19 / $61.00 / $71.80
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.17 / $63.50 / $74.70